Basic Information
| Provider Information | |||||||||
| NPI: | 1326120957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEMING | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3826 SOLUTIONS CTR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606773008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173555837 | ||||||||
| FaxNumber: | 3173552205 | ||||||||
| Practice Location | |||||||||
| Address1: | 10122 E 10TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462292663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173555717 | ||||||||
| FaxNumber: | 3173553760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 06/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01040475 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00292119 | 01 | IN | RAILROAD MEDICARE | OTHER | 100329200 | 05 | IN | MEDICAID | 0000003792 | 01 | IN | ANTHEM LEGACY | OTHER | 100329200B | 05 | IN | MEDICAID |