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1649274317

NPI Code Detail

MEDICARE: DR. SIMON FU FENG MD

MEDICARE: DR. SIMON FU FENG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01045681A	IN
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	01045681	IN
3	208VP0000X	Pain Medicine Physician	01045681A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080098625	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649274317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON FU FENG MD

Provider Business Mailing Address
First Line	:	821 N STATE ROAD 135
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1314
Country	:	US
Telephone Number	:	317-560-4300
Fax Number	:	317-530-9084

Provider Business Practice Location Address
First Line	:	821 N STATE ROAD 135
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1314
Country	:	US
Telephone Number	:	317-560-4300
Fax Number	:	317-530-9084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/31/2024

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Directions to “ DR. SIMON FU FENG MD” Practice Location

Language	Start Address	Practice Location

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