Healthcare Provider Details

I. General information

NPI: 1790893832
Provider Name (Legal Business Name): DAVID MICHAEL FESAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 BUR OAK CT
AVON IN
46123-9476
US

IV. Provider business mailing address

1250 BUR OAK CT
AVON IN
46123-9476
US

V. Phone/Fax

Practice location:
  • Phone: 317-439-4334
  • Fax: 317-272-3228
Mailing address:
  • Phone: 317-439-4334
  • Fax: 317-272-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000972A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: