Dr. Martin Ryan Fetzer, D.O.
Physical Medicine & Rehabilitation, Pain Medicine in Lombard, IL. Individual provider (NPI-1).
NPI number1649499476
StatusActive
Last updated in NPPESAug 7, 2023
Details
- NPI
- 1649499476
- Entity type
- Individual (NPI-1)
- Name
- Dr. Martin Ryan Fetzer
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 24, 2007
- Certification date
- Aug 7, 2023
- Last updated
- Aug 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2081P2900X | Physical Medicine & Rehabilitation, Pain Medicine | 036129085 | IL | Yes |
| 208100000X | Physical Medicine & Rehabilitation | OS014454 | PA | |
| 208100000X | Physical Medicine & Rehabilitation | 5101017042 | MI | |
| 208100000X | Physical Medicine & Rehabilitation | 036129085 | IL |
Practice location
1801 S Highland Ave Ste 220Lombard, IL 60148-4932
Phone 630-967-2225 · Fax 630-241-6906
Mailing address
Po Box 713260Chicago, IL 60677-1260
Phone 630-469-9200
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Physical Medicine & Rehabilitation, Pain Medicine providers in Lombard, IL
Checking a whole list?
Paste up to 5,000 NPIs and download status, name, taxonomy, license and address for each one. Useful for credentialing, billing and pharmacy claim checks.