Individual
DR. HONESTO K FENOL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 E MAIN ST, STE 110, PETERSBURG, IN 47567-1270
(812) 354-8426
(812) 354-9134
Mailing address
611 E MAIN ST, STE 110, PETERSBURG, IN 47567-1270
(812) 354-8426
(812) 354-9134
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028253A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000329621
ANTHEM
IN
05
—
100203420
—
IN
01
—
CG3197
MEDICARE RAILROAD GROUP
IN
01
—
P00116061
MEDICARE RAILROAD
IN
Enumeration date
03/08/2006
Last updated
01/15/2016
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