Provider Demographics
NPI:1407878598
Name:FESSENDEN, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:FESSENDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2404
Mailing Address - Fax:970-490-4340
Practice Address - Street 1:1900 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5114
Practice Address - Country:US
Practice Address - Phone:970-350-2426
Practice Address - Fax:970-350-2478
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200300465208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2015787Medicare PIN
NCH69266Medicare UPIN