Healthcare Provider Details

I. General information

NPI: 1184291874
Provider Name (Legal Business Name): GREGORY MICHAEL FESZ NDTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W MAIN ST
BELLEVUE OH
44811-9088
US

IV. Provider business mailing address

6500 BARTON RD
NORTH OLMSTED OH
44070-4752
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-4040
  • Fax:
Mailing address:
  • Phone: 440-465-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: