Organization
20TH STREET CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN FEDELE DO (OWNER)
(269) 969-6010
Entity
Organization
Contact information
Practice address
105 N 20TH ST, BATTLE CREEK, MI 49015-1746
(269) 969-6010
(269) 964-8422
Mailing address
105 N 20TH ST, BATTLE CREEK, MI 49015-1746
(269) 969-6010
(269) 964-8422
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101004673
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010057408
RR MCR P-TAN
—
01
—
080A310650
BCBS
MI
05
—
111023860
—
MI
01
—
464295
ADVANTRA FREEDOM
MI
01
—
5130499
MEDICARE ADVANTAGE
—
01
—
CJ8333
RR MCR
—
Enumeration date
11/14/2007
Last updated
03/27/2013
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