Healthcare Provider Details

I. General information

NPI: 1396788964
Provider Name (Legal Business Name): MORGAN M FLECK MS, RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 2ND ST
BLOOMINGTON IN
47403-2317
US

IV. Provider business mailing address

4101 W ARDSLEY LN
BLOOMINGTON IN
47404-9149
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-9405
  • Fax:
Mailing address:
  • Phone: 260-463-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001612A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: