1487633392 NPI number — DR. APRIL M FETZER D.O.

Table of content: DR. APRIL M FETZER D.O. (NPI 1487633392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487633392 NPI number — DR. APRIL M FETZER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FETZER
Provider First Name:
APRIL
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487633392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WESTBROOK CORPORATE CTR
Provider Second Line Business Mailing Address:
#240
Provider Business Mailing Address City Name:
WESTCHESTER
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60154-5701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7331 COLLEGE PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-5524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-337-2003
Provider Business Practice Location Address Fax Number:
239-337-3168
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  036111564 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: OS16123 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1633878 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036111564 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7205467 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207067 . This is a "MEDICARE PTAN LOCALITY 16" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 207073 . This is a "MEDICARE PTAN LOCALITY 15" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DA4902 . This is a "RAILROAD MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00180883 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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