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General NPI Number Information
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NPI Number | 1639149545
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Entity Type | Individual
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Provider Name | MARK FESEN MD
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 204 CLEVELAND ST
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City | GREAT BEND
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State | KS
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Zip | 67530-3563
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Country | US
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Telephone | 620-792-5511
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Fax | 620-792-5977
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Provider Business Mailing Address
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Address Line | PO BOX 256
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City | SALINA
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State | KS
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Zip | 67402-0256
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Country | US
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Telephone | 785-823-0633
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Fax | 785-823-0658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 04-24425
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License Number State | KS
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