Organization
JOHN RAYMOND FENYK, JR
Active
Other names
Midwest Dermatoloty
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNETTE L SELVIG (BUSINESS OFFICE)
(763) 545-8614
Entity
Organization
Contact information
Practice address
5647 DULUTH ST, GOLDEN VALLEY, MN 55422-4054
(763) 545-8614
(763) 545-1935
Mailing address
5647 DULUTH ST, GOLDEN VALLEY, MN 55422-4054
(763) 545-8614
(763) 545-1935
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
23247
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-00003
MEDICA PRIMARY
MN
01
—
03-03331
MEDICA CHOICE
MN
01
—
04440FE
BCBS
MN
01
—
384
HEALTH PARTNERS
MN
01
—
716001
PREFERRED ONE
MN
Enumeration date
12/28/2006
Last updated
08/22/2020
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