Individual
BERNARD FOGELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3611 S REED RD, SUITE 103, KOKOMO, IN 46902-3828
(765) 864-5786
(765) 864-5787
Mailing address
8180 CLEARVISTA PARKWAY, SUITE 230, INDIANAPOLIS, IN 46256-4649
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01058072A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200450400
—
IN
Enumeration date
07/08/2005
Last updated
12/20/2013
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