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1922090901

NPI Code Detail

MEDICARE: DR. MARVIN R FETTER MD

MEDICARE: DR. MARVIN R FETTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	036-045536	IL
2	207X00000X	Orthopaedic Surgery Physician	39401-020	WI
3	207X00000X	Orthopaedic Surgery Physician	54685	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922090901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN R FETTER MD

Provider Business Mailing Address
First Line	:	1300 ANNE ST NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5103
Country	:	US
Telephone Number	:	218-751-9746
Fax Number	:	218-759-0620

Provider Business Practice Location Address
First Line	:	1300 ANNE ST NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5103
Country	:	US
Telephone Number	:	218-751-9746
Fax Number	:	218-759-0620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	05/05/2014

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Directions to “ DR. MARVIN R FETTER MD” Practice Location

Language	Start Address	Practice Location

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