Provider Demographics
NPI:1548319221
Name:GRETCHEN M FELLER MD PC
Entity type:Organization
Organization Name:GRETCHEN M FELLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-384-1660
Mailing Address - Street 1:331 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4393
Mailing Address - Country:US
Mailing Address - Phone:734-384-1660
Mailing Address - Fax:734-457-9030
Practice Address - Street 1:331 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4393
Practice Address - Country:US
Practice Address - Phone:734-384-1660
Practice Address - Fax:734-457-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089113208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG73222Medicare UPIN