Provider Demographics
NPI:1962624437
Name:OCCUPATIONAL MEDICINE CONSULTANTS, LTD
Entity type:Organization
Organization Name:OCCUPATIONAL MEDICINE CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JETZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-920-5663
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-0380
Mailing Address - Country:US
Mailing Address - Phone:952-920-5663
Mailing Address - Fax:952-928-9006
Practice Address - Street 1:6515 BARRIE ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-920-5663
Practice Address - Fax:952-928-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine