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NPI Code Detail

MEDICARE: DEANNA M FENOUGHTY M.D.

MEDICARE: DEANNA M FENOUGHTY M.D.
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
1207V00000XObstetrics & Gynecology Physician01056031AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245218908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA M FENOUGHTY M.D.
Provider Business Mailing Address
First Line : 1100 SOUTHFIELD DR
Second Line : SUITE 1370
City : PLAINFIELD
State : IN
Zip : 46168-4498
Country : US
Telephone Number : 317-837-5571
Fax Number : 317-837-5580
Provider Business Practice Location Address
First Line : 6911 E US HIGHWAY 36
Second Line :
City : AVON
State : IN
Zip : 46123-8926
Country : US
Telephone Number : 317-272-8033
Fax Number : 317-272-8044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 03/04/2021

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