MEDICARE: CARL W FIESER MD

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	2085R0202X	Diagnostic Radiology Physician	04-16118	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	KA1172003	OTHER	KS	MEDICARE
5	CO40688	OTHER	CO	MEDICARE COLORADO
7	KA1173003	OTHER	KS	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1316990849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL W FIESER MD

Provider Business Mailing Address
First Line	:	2004 1ST AVE
Second Line	:	STE A
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2623
Country	:	US
Telephone Number	:	620-225-1033
Fax Number	:	620-227-8491

Provider Business Practice Location Address
First Line	:	2004 1ST AVE
Second Line	:	STE A
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2623
Country	:	US
Telephone Number	:	620-225-1033
Fax Number	:	620-227-8491

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/07/2017

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Directions to “ CARL W FIESER MD” Practice Location

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