Fenner, Michael Niel

Fenner, Michael Niel is an individual health care provider with primary practice located at 1600 W Walnut St , Jacksonville IL 62650-1136. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Fenner, Michael Niel can be contacted via phone (217) 528-7541.

Contact Information

Primary practice address
1600 W Walnut St Jacksonville IL 62650-1136
Phone: (217) 528-7541
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 5616 Alaska
Allopathic & Osteopathic Physicians / Surgery 208600000X 036080188 Illinois

Profile Details

NPI number 1578660445
LBN Legal business name Fenner, Michael Niel
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Feb 4th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578660445 NPPES
Illinois Other R01571 MEDICARE PTAN
Illinois MEDICAID MD3077 MEDICARE PTAN

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