Healthcare Provider Details

I. General information

NPI: 1487651758
Provider Name (Legal Business Name): ANDREW J FIEDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

62480 TURKEY TRL
SOUTH BEND IN
46614-9416
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1000
  • Fax:
Mailing address:
  • Phone: 574-850-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01043726A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: