John Raymond Fenyk, Jr

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

23247 Issued in MN

Legal business name

JOHN RAYMOND FENYK, JR

Doing business as

Midwest Dermatoloty

Practice address

5647 Duluth St
Golden Valley, MN 55422-4054

Phone

(763) 545-8614

Fax

(763) 545-1935

NPI assigned

Dec 28, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Annette L Selvig

Title

Business Office

Phone

(763) 545-8614

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Midwest Dermatoloty Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Raymond Fenyk Jr., M.D.

  • Dermatology Physician
  • Minneapolis, MN
  • NPI 1265463129
  NPD (past)
• Payam Abrishami, MD

  • Dermatology Physician
  • Agoura Hills, CA
  • NPI 1447288147
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407912389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5647 DULUTH ST",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224054",
            "telephone_number": "763-545-8614",
            "fax_number": "763-545-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5647 DULUTH ST",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224054",
            "telephone_number": "763-545-8614",
            "fax_number": "763-545-1935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN RAYMOND FENYK, JR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SELVIG",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS OFFICE",
        "authorized_official_telephone_number": "763-545-8614",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "23247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "716001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "03-00003",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "384",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "04440FE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "03-03331",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dermatoloty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shelby Joy Jensen
• Vanessa Dawn Jewell
• Jewish Family & Children's Service of Minneapolis
• Jewish Family & Children's Service of MPLS
• Jewish Family and Children's Service
• Bethaney Colette Johnson, PHARMD
• Brittany Heather Johnson
• Chance Macauley Johnson, DC
• Christopher Stewart Johnson, DCM, LAC
• Kaitlin Johnson

• Dermatology Physician in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.