MEDICARE: HIROAKI FUJIMOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1124732888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIROAKI FUJIMOTO

Provider Business Mailing Address
First Line	:	400 E MELROSE AVE
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-1904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E MELROSE AVE
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-1904
Country	:	US
Telephone Number	:	812-361-7985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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Directions to “ HIROAKI FUJIMOTO ” Practice Location

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