Provider Demographics
NPI:1871637272
Name:FEDOR, GENE VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:VICTOR
Last Name:FEDOR
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:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0306
Mailing Address - Country:US
Mailing Address - Phone:219-947-5606
Mailing Address - Fax:
Practice Address - Street 1:1400 S LAKE PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6636
Practice Address - Country:US
Practice Address - Phone:219-947-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043359A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184715OtherBLUE CROSS BLUE SHIELD
IN000000184715OtherBLUE CROSS BLUE SHIELD
ING06842Medicare UPIN