Individual
JOHN F FIEDERLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1411 S CREASY LN, SUITE 130, LAFAYETTE, IN 47905-7438
(765) 447-7447
(765) 807-0553
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01055952A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000220414
ANTHEM PROVIDER NUMBER
IN
05
—
200394920
—
IN
Enumeration date
03/14/2006
Last updated
01/09/2024
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