Healthcare Provider Details

I. General information

NPI: 1225337934
Provider Name (Legal Business Name): TATHYANA MARQUES FERNANDES FENSTERER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TATHYANA MARQUES FERNANDES FENSTERER M.D.

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 E CREEKS EDGE DR
BLOOMINGTON IN
47401-8368
US

IV. Provider business mailing address

2605 E CREEKS EDGE DR
BLOOMINGTON IN
47401-8368
US

V. Phone/Fax

Practice location:
  • Phone: 812-676-4430
  • Fax:
Mailing address:
  • Phone: 812-676-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number01101069A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: