MEDICARE: KEVIN FETZER

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1083741318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN FETZER

Provider Business Mailing Address
First Line	:	227 THORN AVE
Second Line	:	PO BOX 631
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2600
Country	:	US
Telephone Number	:	716-662-2040
Fax Number	:	716-662-0019

Provider Business Practice Location Address
First Line	:	1280 MAIN ST
Second Line	:	3RD FLOOR
City	:	BUFFALO
State	:	NY
Zip	:	14209-1912
Country	:	US
Telephone Number	:	716-832-1251
Fax Number	:	716-832-1271

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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Directions to “ KEVIN FETZER ” Practice Location

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