Basic Information
| Provider Information | |||||||||
| NPI: | 1588642763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEHER | ||||||||
| FirstName: | MARTHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 W GREENLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489102819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173778396 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301069257 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3335697 | 05 | MI | MEDICAID | 350C36152 | 01 | MI | BLUE CARE NETWORK | OTHER | 201512 | 01 | MI | HEALTH ADVANTAGE | OTHER | 201512 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 350C36152 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 350C36152 | 01 | MI | COMMUNITY BLUE | OTHER | C4864 | 01 | MI | MCARE | OTHER | 7500167 | 01 | MI | PHYSICIANS HEALTH PLAN | OTHER |