Healthcare Provider Details

I. General information

NPI: 1124099585
Provider Name (Legal Business Name): MATHIAS H FETTIG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 CENTRAL AVE STE B
BILLINGS MT
59102-6647
US

IV. Provider business mailing address

3419 CENTRAL AVE STE B
BILLINGS MT
59102-6647
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-0888
  • Fax: 406-245-1322
Mailing address:
  • Phone: 406-245-0888
  • Fax: 406-245-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number80
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: