Individual
DERRICK D FENCHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1575 BEAM AVE, MAPLEWOOD, MN 55109-1126
(651) 232-7348
Mailing address
2829 UNIVERSITY AVE SE STE 730, MINNEAPOLIS, MN 55414-3279
(612) 439-1868
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
55276
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
06/16/2011
Last updated
05/04/2021
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