Carl John Fedyszyn, M.D.,P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

7326 Issued in ND

Legal business name

CARL JOHN FEDYSZYN, M.D.,P.C.

Practice address

4550 47TH St S Apt 102
Fargo, ND 58104-4360

Phone

(701) 330-9616

NPI assigned

Jan 29, 2007

Last updated

Apr 20, 2008By 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

Carl John Fedyszyn, M.D.

Title

President

Phone

(701) 330-9616

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1679619860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 47TH ST S APT 102",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044360",
            "telephone_number": "701-330-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 47TH ST S APT 102",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044360",
            "telephone_number": "701-330-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARL JOHN FEDYSZYN, M.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "FEDYSZYN",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-330-9616",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "7326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12146",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.