Provider Demographics
NPI:1225016850
Name:FETTINGER, STEVEN GREG (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GREG
Last Name:FETTINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 MACKINAW RD
Mailing Address - Street 2:STE 6100
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9515
Mailing Address - Country:US
Mailing Address - Phone:989-792-3100
Mailing Address - Fax:989-792-9860
Practice Address - Street 1:5400 MACKINAW RD
Practice Address - Street 2:STE 6100
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604
Practice Address - Country:US
Practice Address - Phone:989-792-3100
Practice Address - Fax:989-792-9860
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035350207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P67636OtherBLUE CARE NETWORK ID #
MI101258650Medicaid
MI101258650Medicaid
B48704Medicare UPIN