Provider Demographics
NPI:1326120957
Name:FLEMING, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:FLEMING
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 1:3826 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3008
Mailing Address - Country:US
Mailing Address - Phone:317-355-5837
Mailing Address - Fax:317-355-2205
Practice Address - Street 1:10122 E 10TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2663
Practice Address - Country:US
Practice Address - Phone:317-355-5717
Practice Address - Fax:317-355-3760
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00292119OtherRAILROAD MEDICARE
IN100329200Medicaid
IN0000003792OtherANTHEM LEGACY
IN100329200BMedicaid
INM400035023Medicare PIN
IN823720HHHHMedicare PIN
IN100329200BMedicaid
IN743210AMedicare PIN