1497940571 NPI number — DR. JULIE JEANETTE FELT MD,MMM

Table of content: DR. JULIE JEANETTE FELT MD,MMM (NPI 1497940571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497940571 NPI number — DR. JULIE JEANETTE FELT MD,MMM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELT
Provider First Name:
JULIE
Provider Middle Name:
JEANETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,MMM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497940571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49443-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-611-1512
Provider Business Mailing Address Fax Number:
231-728-4789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 LEAHY ST
Provider Second Line Business Practice Location Address:
SUITE 201A
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-672-7800
Provider Business Practice Location Address Fax Number:
231-672-7801
Provider Enumeration Date:
09/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301054855 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1497940517 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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