Provider Demographics
NPI:1952707226
Name:OHIO PODIATRIC PHYSICIAN AND SURGEONS GROUP, LLC
Entity Type:Organization
Organization Name:OHIO PODIATRIC PHYSICIAN AND SURGEONS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FETZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-724-8689
Mailing Address - Street 1:335 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1218
Mailing Address - Country:US
Mailing Address - Phone:330-724-8689
Mailing Address - Fax:330-724-5470
Practice Address - Street 1:335 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1218
Practice Address - Country:US
Practice Address - Phone:330-724-8689
Practice Address - Fax:330-724-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2423F213EP1101X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty