Individual
ZHAIJUN FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1815 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 647-1750
(574) 647-1748
Mailing address
710 N. NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003570A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200977390
—
IN
Enumeration date
06/29/2007
Last updated
04/01/2021
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