Basic Information
Provider Information
NPI: 1215937693
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FEGER
FirstName: TIMOTHY
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9800 SHELBYVILLE RD
Address2: SUITE #220
City: LOUISVILLE
State: KY
PostalCode: 402232992
CountryCode: US
TelephoneNumber: 5024298585
FaxNumber: 8556567325
Practice Location
Address1: 9800 SHELBYVILLE RD
Address2: SUITE #220
City: LOUISVILLE
State: KY
PostalCode: 402232992
CountryCode: US
TelephoneNumber: 5024298585
FaxNumber: 5024296157
Other Information
ProviderEnumerationDate: 07/28/2005
LastUpdateDate: 03/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207K00000X01043869AINN Allopathic & Osteopathic PhysiciansAllergy & Immunology 
207K00000X28022KYY Allopathic & Osteopathic PhysiciansAllergy & Immunology 

ID Information
IDTypeStateIssuerDescription
5000158801 PASSPORT HEALTH PLANOTHER
6428022505KY MEDICAID
20003652005IN MEDICAID


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