Provider Demographics
NPI:1609191998
Name:FEARNOT-KLIGERMAN, ANNETTE CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:CHRISTINE
Last Name:FEARNOT-KLIGERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:CHRISTINE
Other - Last Name:FEARNOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2605 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 W OAK ST STE 101
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-3835
Practice Address - Country:US
Practice Address - Phone:317-733-6300
Practice Address - Fax:317-733-6315
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070828A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201099530Medicaid