Provider Demographics
NPI:1902873946
Name:FENOL, HONESTO K JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HONESTO
Middle Name:K
Last Name:FENOL
Suffix:JR
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 1:611 E MAIN ST
Mailing Address - Street 2:STE 110
Mailing Address - City:PETERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47567-1270
Mailing Address - Country:US
Mailing Address - Phone:812-354-8426
Mailing Address - Fax:812-354-9134
Practice Address - Street 1:611 E MAIN ST
Practice Address - Street 2:STE 110
Practice Address - City:PETERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47567-1270
Practice Address - Country:US
Practice Address - Phone:812-354-8426
Practice Address - Fax:812-354-9134
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028253A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000329621OtherANTHEM
INCG3197OtherMEDICARE RAILROAD GROUP
IN100203420Medicaid
INP00116061OtherMEDICARE RAILROAD
INCG3197OtherMEDICARE RAILROAD GROUP
INP00116061OtherMEDICARE RAILROAD
C25418Medicare UPIN