MICHAEL LYNN FETTEROLF (NPI# 1821069691) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821069691 |
| Entity Type | Individual |
| Full Name | MICHAEL LYNN FETTEROLF |
| Credential | MD |
| Practice Address |
1405 Mill St New London WI 54961-2155 |
| Mailing Address |
Po Box 8003 Appleton WI 54912-8003 |
| Practice Telephone | 9205312400 |
| Mailing Telephone | 9209963200 |
| Mailing Fax Number | 9207385787 |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 55231-20 | WI | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD031976E | PA | Allopathic & Osteopathic Physicians |
| N | 207VX0000X |
Obstetrics & Gynecology Specialization: Obstetrics |
MD031976E | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | MEDICARE PTAN | 450030702 | 01 |
| PA | 0010419750001 | 05 | |
| PA | RAILROAD MEDICARE | 160011217 | 01 |
| Street Address |
1405 MILL ST |
| City | NEW LONDON |
| State | WI |
| Zip Code | 54961-2155 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598752057 | Hiep T Poppy | Physical Therapy Assistant | 1405 Mill St, New London, WI 54961-2155 | 2005-09-30 |
| 1952918328 | Emily Becher | Physical Therapist | 1405 Mill St, New London, WI 54961-2155 | 2020-09-29 |
| 1699232132 | Alyssa Wentworth | Physician Assistant | 1405 Mill St, New London, WI 54961-2155 | 2019-02-20 |
| 1609390855 | Leah M Lemke | Physician Assistant | 1405 Mill St, New London, WI 54961-2155 | 2017-07-31 |
| 1548783228 | Kelsey Mae Abendroth | Physical Therapist | 1405 Mill St, New London, WI 54961-2155 | 2017-07-25 |
| 1609397280 | Mayka L Rambo | Registered Nurse | 1405 Mill St, New London, WI 54961-2155 | 2017-07-04 |
| 1275087207 | Ryan Wagner | Emergency Medicine | 1405 Mill St, New London, WI 54961-2155 | 2016-08-08 |
| 1679932750 | Kristin M Roesler | Nurse Practitioner | 1405 Mill St, New London, WI 54961-2155 | 2016-02-17 |
| 1740675040 | Bryan Kent Hendrickson | Family Medicine | 1405 Mill St, New London, WI 54961-2155 | 2015-04-02 |
| 1972928463 | New London Family Medical Center Inc | Non-Pharmacy Dispensing Site | 1405 Mill St, New London, WI 54961-2155 | 2014-02-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407406408 | Cheryl Schneider | Technician | L 56 Northgate Estates, New London, WI 54961 | 2019-09-12 |
| 1861634719 | Rebecca L Kramer | Counselor | 315 Burton St, New London, WI 54961 | 2009-03-24 |
| 1598913501 | Marsha Ann Nytes | Licensed Practical Nurse | E8222 Weyawega Rd, New London, WI 54961 | 2008-09-03 |
| 1659585172 | Amanda L. Beck | Physical Therapy Assistant | 400 E. 4th Street, Manawa, WI 54961 | 2007-05-10 |
| 1366599433 | Griebenow Eyecare, S.c. | Optometrist | 105 Northridge Drive, New London, WI 54961 | 2007-01-04 |
| 1740822055 | Lauren Mae Flunker | Social Worker | E7475 Rawhide Rd, New London, WI 54961 | 2019-10-09 |
| 1063641249 | Forefront Dermatology, S.c. | Dermatology | 1620 N Shawano St, Suite C, New London, WI 54961 | 2009-07-08 |
| 1093982530 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1420 Algoma St, New London, WI 54961 | 2008-05-14 |
| 1821263849 | Mark Alan Tegtmeier | Counselor | E7475 Rawhide Rd, New London, WI 54961 | 2008-04-30 |
| 1639282544 | Ascension Medical Group-fox Valley Wisconsin, Inc | Durable Medical Equipment & Medical Supplies | 1420 Algoma St, New London, WI 54961 | 2006-08-16 |
| Find all providers in zip 54961 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881195048 | Glenn Edward Mott | Family Medicine | 74 Pleasant St Ste 204, New London, NH 03257-5881 | 2018-02-23 |
| 1316124043 | Heritage Family Care LLC | Family Medicine | 470 Bank St, New London, CT 06320-5548 | 2008-01-24 |
| 1093992000 | Christine Ann Dube | Family Medicine | 273 Country Road, New London, NH 03257 | 2008-01-22 |
| 1679761423 | Southeastern Connecticut Medical Associates, PC | Family Medicine | 447 Montauk Ave, New London, CT 06320-4605 | 2007-10-05 |
| 1922215946 | Anthony Joseph Yuskaitis | Family Medicine | 868 Morgan Hill Rd., New London, NH 03257 | 2007-05-17 |
| 1669568309 | Gary M. Bertman | Family Medicine | 157 Montauk Ave, New London, CT 06320-4842 | 2006-10-04 |
| 1154416782 | Peter J. Gates | Family Medicine | 157 Montauk Avenue, New London, CT 06320 | 2006-10-03 |
| 1972519213 | Amber O Vick | Family Medicine | 600 Peterson Parkway, Affiliated Community Medical Centers, New London, MN 56273 | 2006-07-31 |
| 1467482653 | Leticia V Filip | Family Medicine | 153 Montauk Ave, New London, CT 06320-4842 | 2006-07-03 |
| 1174585442 | Josiephina Castro Souza | Family Medicine | U.S.coast Guard Academy Medical, 15 Mohegan Ave, New London, CT 06320 | 2006-04-03 |
| Find all providers in NEW LONDON | ||||
| City | NEW LONDON |
| Zip Code | 54961 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.