Provider Demographics
NPI:1053462457
Name:FIEDLER, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:59 CAVALIER BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3901
Mailing Address - Country:US
Mailing Address - Phone:859-371-3232
Mailing Address - Fax:859-371-6943
Practice Address - Street 1:59 CAVALIER BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3901
Practice Address - Country:US
Practice Address - Phone:859-371-3232
Practice Address - Fax:859-371-6943
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY31816208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics