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Individual

DR. LESTER J. FAHRNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1248
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036-077871
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036077871 1
IL
01
070004611
RAILROAD MEDICARE
01
279500
MEDICARE GROUP
Enumeration date
08/01/2006
Last updated
10/15/2014
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