Provider Demographics
NPI:1629181094
Name:FLEMING, JANICE LEA (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:LEA
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18895 BEROUN CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063
Mailing Address - Country:US
Mailing Address - Phone:320-629-6692
Mailing Address - Fax:
Practice Address - Street 1:301 S HWY 65
Practice Address - Street 2:KANABEE HOSPITAL
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051
Practice Address - Country:US
Practice Address - Phone:320-679-1212
Practice Address - Fax:320-225-3429
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110193772OtherRAILROAD MEDICARE
MN73D27FLOtherBLUE CROSS
MN0404572OtherMEDICA
MN164400OtherUCARE
MN102897900Medicaid
MN73D28FLOtherBLUE CROSS
MN0404572OtherMEDICA
MN110006094Medicare ID - Type Unspecified