MEDICARE: PHILIP A RETTENMAIER DO

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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	02001284A	IN

General Provider Information

NPI Number	:	1871593418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP A RETTENMAIER DO

Provider Business Mailing Address
First Line	:	1355 GETZ RD STE C
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1609
Country	:	US
Telephone Number	:	260-413-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 GETZ RD STE C
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1609
Country	:	US
Telephone Number	:	260-413-5879
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/27/2025

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