Individual
DR. MARK S FELDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
311 W LINCOLN ST, SUITE 100, BELLEVILLE, IL 62220-1902
(618) 233-3661
(618) 233-0992
Mailing address
311 W LINCOLN ST, SUITE 100, BELLEVILLE, IL 62220-1902
(618) 233-3661
(618) 233-0992
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036058043
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058043
—
IL
01
—
371123307
TAX ID #
IL
Enumeration date
01/20/2006
Last updated
04/18/2013
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