Provider Demographics
NPI:1083698633
Name:RETTMANN, HOWARD L (PA-C)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:L
Last Name:RETTMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2221 LINSMEYER RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-9133
Mailing Address - Country:US
Mailing Address - Phone:920-833-2646
Mailing Address - Fax:
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-445-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI495-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42918000Medicaid
WI9700090004OtherMEDICARE RAILROAD
WI000022Medicare Oscar/Certification
WI9700090004OtherMEDICARE RAILROAD
WI000057Medicare Oscar/Certification
WI000058Medicare Oscar/Certification
WI001145034Medicare Oscar/Certification
WI42918000Medicaid
WI000155Medicare Oscar/Certification
WI071700032Medicare Oscar/Certification
WI002407660Medicare Oscar/Certification
WI590050050Medicare Oscar/Certification
WI000024Medicare Oscar/Certification
WI430751197Medicare Oscar/Certification
WI001771116Medicare Oscar/Certification