Fetzer, Martin Ryan

Fetzer, Martin Ryan is an individual health care provider with primary practice located at 1801 S Highland Ave Ste 220 , Lombard IL 60148-4932. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Fetzer, Martin Ryan can be contacted via phone (630) 967-2225.

Contact Information

Primary practice address
1801 S Highland Ave Ste 220 Lombard IL 60148-4932
Phone: (630) 967-2225
Fax: (630) 241-6906
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X OS014454 Pennsylvania
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 5101017042 Michigan
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 036129085 Illinois
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 036129085 Illinois

Profile Details

NPI number 1649499476
LBN Legal business name Fetzer, Martin Ryan
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 24th, 2007
Last updated Aug 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649499476 NPPES
Illinois MEDICAID 036129085

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