Provider Demographics
NPI:1942759295
Name:FELDPAUSCH, MARCUS D (PA-C)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:D
Last Name:FELDPAUSCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 W M 21 STE 101
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:MI
Mailing Address - Zip Code:48866-9798
Mailing Address - Country:US
Mailing Address - Phone:989-834-2243
Mailing Address - Fax:989-834-5478
Practice Address - Street 1:9900 W M 21 STE 101
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9798
Practice Address - Country:US
Practice Address - Phone:989-834-2243
Practice Address - Fax:989-834-5478
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007955363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942759295Medicaid