Provider Demographics
NPI:1043382591
Name:FELIPE VIDELA MD PC
Entity type:Organization
Organization Name:FELIPE VIDELA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-0710
Mailing Address - Street 1:G5154 MILLER RD
Mailing Address - Street 2:SUITE CN
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-733-0710
Mailing Address - Fax:810-733-0715
Practice Address - Street 1:G5154 MILLER RD
Practice Address - Street 2:SUITE CN
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-733-0710
Practice Address - Fax:810-733-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010293452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P49350Medicare PIN
D85222Medicare UPIN