Individual
MARK FESENMYER
Active
Individual
MARK FESENMYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01072085A
IN
207RG0100X
Gastroenterology Physician
036105597
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000804383
ANTHEM
IN
05
—
036105597
—
IL
05
—
201131780A
—
IN
Enumeration date
02/20/2006
Last updated
05/05/2020
Update your record
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