Fesenmyer, Mark
Fesenmyer, Mark is an individual health care provider with primary practice located at 8895 Broadway , Merrillville IN 46410-7037. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Fesenmyer, Mark can be contacted via phone (219) 738-2081.Contact Information
Primary practice address
8895 Broadway
Merrillville IN 46410-7037
Phone: (219) 738-2081
Fax: (219) 736-4658
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 036105597 | Illinois |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 01072085A | Indiana |
Profile Details
| NPI number | 1992770390 |
|---|---|
| LBN Legal business name | Fesenmyer, Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 20th, 2006 |
| Last updated | May 5th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992770390 | NPPES |
| Indiana | Other | 000000804383 | ANTHEM |
| Indiana | MEDICAID | 036105597 | ANTHEM |
| Indiana | MEDICAID | 201131780A | ANTHEM |
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