Healthcare Provider Details

I. General information

NPI: 1346690773
Provider Name (Legal Business Name): MICHAEL BRIAN FECHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 CHARLTON CT
GOSHEN IN
46526-6464
US

IV. Provider business mailing address

1811 CHARLTON CT
GOSHEN IN
46526-6464
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-8200
  • Fax:
Mailing address:
  • Phone: 574-534-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11018865A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01082237A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: