Iryl Felicidario
Individual provider Active NPI Contractor · Troy, MI
NPI 1689100273 · NPPES record last updated Jul 29, 2019
Key facts
- NPI
- 1689100273
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- AS500012029 (MI)
- Practice address
- 2033 Harned Dr
Troy, MI 48085-1046 - Phone
- (248) 689-2056
- Fax
- (248) 689-4283
- NPI assigned
- May 3, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AS500012029 | MI | MD | Contractor |
| AS500363588 | MI | MD | Contractor |
| AS630066532 | MI | MD | Contractor |
| AS630079486 | MI | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ultra Care, Inc. | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | AS630066532 | MI | |
| Contractor | 171W00000X | AS630079486 | MI | |
| Contractor | 171W00000X | AS500363588 | MI | |
| Contractor | 171W00000X | AS500012029 | MI | Yes |
Addresses
Primary practice location
2033 Harned Dr
Troy, MI 48085-1046
Mailing address
2033 Harned Dr
Troy, MI 48085-1046
Phone (248) 689-2056
Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.