Individual
MARK FESENMYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8895 BROADWAY, MERRILLVILLE, IN 46410-7037
(219) 738-2081
(219) 736-4658
Mailing address
8895 BROADWAY, MERRILLVILLE, IN 46410-7037
(219) 738-2081
(219) 736-4658
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
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