Healthcare Provider Details

I. General information

NPI: 1184620403
Provider Name (Legal Business Name): WILLIAM JOHN FECHT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N MERIDIAN ST SUITE 225
INDIANAPOLIS IN
46260-5382
US

IV. Provider business mailing address

8902 N MERIDIAN ST SUITE 225
INDIANAPOLIS IN
46260-5382
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-1161
  • Fax: 317-875-3286
Mailing address:
  • Phone: 317-872-1161
  • Fax: 317-875-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01060020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: