Provider Demographics
NPI:1487633392
Name:FETZER, APRIL M (DO)
Entity Type:Individual
Prefix:DR
First Name:APRIL
Middle Name:M
Last Name:FETZER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:#240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7331 COLLEGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5524
Practice Address - Country:US
Practice Address - Phone:239-337-2003
Practice Address - Fax:239-337-3168
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361115642081P2900X
FLOS161232081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633878OtherBCBS
IL036111564Medicaid
7205467OtherAETNA
IL207067OtherMEDICARE PTAN LOCALITY 16
IL207073OtherMEDICARE PTAN LOCALITY 15
DA4902OtherRAILROAD MEDICARE PTAN
P00180883OtherRAILROAD MEDICARE
P00180883OtherRAILROAD MEDICARE
IL207073OtherMEDICARE PTAN LOCALITY 15
ILK10527Medicare PIN