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Individual

MICHAEL L FESSENDEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2003 W FULTON ST, 3RD FLOOR, CHICAGO, IL 60612-2345
(773) 292-4800
(773) 486-3548
Mailing address
2003 W FULTON ST, 3RD FLOOR, CHICAGO, IL 60612-2345
(773) 292-4800
(773) 486-3548

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2003016360
MO
207Q00000X
Family Medicine Physician
Primary
36118835
IL
207Q00000X
Family Medicine Physician
43269-020
WI
207Q00000X
Family Medicine Physician
8219
ND
207Q00000X
Family Medicine Physician
D66365
MD

Other

Enumeration date
06/20/2005
Last updated
07/15/2007
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