Provider Demographics
NPI:1164460887
Name:FIECHTNER, JUSTUS JOHN (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:JUSTUS
Middle Name:JOHN
Last Name:FIECHTNER
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3394 E JOLLY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8594
Mailing Address - Country:US
Mailing Address - Phone:517-272-9700
Mailing Address - Fax:517-272-9706
Practice Address - Street 1:3394 E JOLLY RD
Practice Address - Street 2:SUITE C
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8594
Practice Address - Country:US
Practice Address - Phone:517-272-9700
Practice Address - Fax:517-272-9706
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301-057361207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000007318OtherPHP OF MICHIGAN
MI1000565OtherMCLAREN HEALTH PLAN
MI110C314380OtherBLUE CROSS GROUP PIN
MI4214622Medicaid
MI660003062OtherRAILROAD MEDICARE
MI4392064OtherAETNA
MID25878Medicare UPIN
MI110C314380OtherBLUE CROSS GROUP PIN