Provider Demographics
NPI:1326013301
Name:FIEDOR, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:FIEDOR
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 1:2905 STRAIGHTLINE PIKE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-7233
Mailing Address - Country:US
Mailing Address - Phone:765-962-8077
Mailing Address - Fax:765-939-3128
Practice Address - Street 1:2021 CHESTER BLVD
Practice Address - Street 2:REID REHABILITATION CENTER
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1235
Practice Address - Country:US
Practice Address - Phone:765-939-7000
Practice Address - Fax:765-827-7972
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025621A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB29693Medicare UPIN
IN210140AMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER