Provider Demographics
NPI:1376845529
Name:RANDY FELDMAN DPM LLC
Entity type:Organization
Organization Name:RANDY FELDMAN DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-676-2080
Mailing Address - Street 1:1501 N MILFORD RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1006
Mailing Address - Country:US
Mailing Address - Phone:248-676-2080
Mailing Address - Fax:
Practice Address - Street 1:1501 N MILFORD RD
Practice Address - Street 2:STE. 200
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1006
Practice Address - Country:US
Practice Address - Phone:248-676-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-20
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P15390OtherMEDICARE PLUS BLUE
6242670002OtherMEDICARE DMEPOS
MI480F337000OtherBLUE CARE NETWORK
MI492996413Medicaid
480F394260OtherBLUE CROSS BLUE SHIELD
MI0P15390OtherMEDICARE
480F394260OtherBLUE CROSS BLUE SHIELD
6242670002OtherMEDICARE DMEPOS