Provider Demographics
NPI:1124099585
Name:FETTIG, MATHIAS H (DPM)
Entity type:Individual
Prefix:
First Name:MATHIAS
Middle Name:H
Last Name:FETTIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 CENTRAL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6647
Mailing Address - Country:US
Mailing Address - Phone:406-245-0888
Mailing Address - Fax:406-245-1322
Practice Address - Street 1:3419 CENTRAL AVE
Practice Address - Street 2:STE B
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6647
Practice Address - Country:US
Practice Address - Phone:406-245-0888
Practice Address - Fax:406-245-1322
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT80213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT01017556OtherUNITED HEALTHCARE
MT94500OtherBCBS
MT80OtherSTATE LICENSE
MTP00062610OtherRAILROAD MEDICARE
MT0390762Medicaid
T13254Medicare UPIN
MTP00062610OtherRAILROAD MEDICARE
MT5107890001Medicare NSC