Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01045681A | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 01045681 | IN |
NPI | 1649274317 |
---|---|
Provider Name | Dr. Simon Fu Feng |
First Address | Greenwood, IN 46142-1314 |
Second Address | Greenwood, IN 46142-1314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080098625 | RAILROAD MEDICARE (01) | IN |
200121760 | (05) | IN |
G45135 | (02) | IN |