Provider Demographics
NPI:1629059951
Name:FELDMAN, RANDY S (DPM)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:S
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31017 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1907
Mailing Address - Country:US
Mailing Address - Phone:248-585-1177
Mailing Address - Fax:248-585-0083
Practice Address - Street 1:31017 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1907
Practice Address - Country:US
Practice Address - Phone:248-585-1177
Practice Address - Fax:248-585-0083
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001043213ES0103X
MIRF001043213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0170034002OtherCIGNA
MI383749866OtherPPOM COFINITY
MIP41010001OtherMEDICARE PLUS BLUE
MI5453041OtherAETNA
MIRF001043OtherBLUE CROSS BLUE SHIELD
MI100763OtherGREAT LAKES HEALTH PLAN
MI5223312Medicaid
MI480003679OtherRAILROAD
MIP41010001OtherMEDICARE ADVANTAGE
MIRF001043OtherBLUE CARE NETWORK
MIRF001043OtherBLUE CROSS FEP
MIT34138OtherHAP
MIMI120001OtherMEDICARE PTAN
MIP41010001OtherMEDICARE ADVANTAGE
MIRF001043OtherBLUE CROSS BLUE SHIELD