Provider Demographics
NPI:1962575936
Name:FUENFER, MICHAEL MELVIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MELVIN
Last Name:FUENFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-0229
Mailing Address - Country:US
Mailing Address - Phone:978-762-4888
Mailing Address - Fax:301-785-3820
Practice Address - Street 1:25 HIGHLAND AVE
Practice Address - Street 2:WOUND CARE CENTER
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3867
Practice Address - Country:US
Practice Address - Phone:978-762-4888
Practice Address - Fax:978-762-3922
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH49938208600000X
CT0281572086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1962575936Medicaid
CT1962575936Medicaid