Provider Demographics
NPI:1316938277
Name:FESENMEIER, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FESENMEIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:866-401-3057
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1541
Practice Address - Country:US
Practice Address - Phone:251-415-1496
Practice Address - Fax:251-415-1450
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.49761207V00000X
OH35083564207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000370623OtherMEDICAL MUTUAL
OH2608057Medicaid
OH313195OtherAMERIGROUP
OH7094699OtherAETNA
OH0705610OtherUNITED HEALTHCARE
OH311575051057OtherCARESOURCE
OH2608057Medicaid
OHI32468Medicare UPIN
OH0705610OtherUNITED HEALTHCARE