Individual
ELTON G. FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 W COLUMBIA ST, STE 110, EVANSVILLE, IN 47710-1656
(812) 450-3363
(812) 450-3071
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-3363
(812) 450-3071
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01074892A
IN
207V00000X
Obstetrics & Gynecology Physician
01074892A
IN
207V00000X
Obstetrics & Gynecology Physician
Primary
235209
MA
207V00000X
Obstetrics & Gynecology Physician
45090
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497705891
—
WI
05
—
2157934
—
MA
Enumeration date
05/10/2006
Last updated
09/11/2025
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