Provider Demographics
NPI:1801882584
Name:FESSLER, RICHARD D II (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:FESSLER
Suffix:II
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 1:29275 NORTHWESTERN HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1044
Mailing Address - Country:US
Mailing Address - Phone:248-784-3667
Mailing Address - Fax:248-784-3678
Practice Address - Street 1:29275 NORTHWESTERN HWY
Practice Address - Street 2:STE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1044
Practice Address - Country:US
Practice Address - Phone:248-784-3667
Practice Address - Fax:248-784-3678
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE49560Medicare UPIN
MI0Q26462Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER