DR. MARVIN R FETTER (NPI# 1922090901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922090901 |
| Entity Type | Individual |
| Full Name | DR. MARVIN R FETTER |
| Credential | MD |
| Practice Address |
1300 Anne St Nw Bemidji MN 56601-5103 |
| Practice Telephone | 2187519746 |
| Practice Fax Number | 2187590620 |
| Mailing Telephone | 2187519746 |
| Mailing Fax Number | 2187590620 |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2014-05-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 54685 | MN | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 39401-020 | WI | Allopathic & Osteopathic Physicians |
| Y | 207X00000X | Orthopaedic Surgery | 036-045536 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 34444000 | 05 | |
| IL | 03604536 | 05 |
| Street Address |
1300 ANNE ST NW |
| City | BEMIDJI |
| State | MN |
| Zip Code | 56601-5103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679129555 | Ashley Marie Wavrin | Nurse Practitioner | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2019-08-15 |
| 1649824996 | Angela Halvorson | Nurse Practitioner | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2019-07-25 |
| 1114589348 | Rachel Marie Vesta | Nurse Practitioner | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2019-07-09 |
| 1407419419 | Ethan Axtman | Nurse Practitioner | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2019-04-16 |
| 1053895201 | Jarad Syrstad | Physical Therapist | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2018-09-23 |
| 1851874416 | Kimberly Miller | Physician Assistant | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2018-09-10 |
| 1780175752 | Billie Jo Dressing | Registered Nurse | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2018-05-24 |
| 1386142818 | Andrea May Lucca | Social Worker | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2018-01-30 |
| 1356859979 | Andrew William Rook | Registered Nurse | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2018-01-17 |
| 1891214466 | Kelley Brooke Olsen | Nurse Anesthetist, Certified Registered | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2017-09-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772425 | Northern Minnesota Addiction Wellness Center | Substance Abuse Rehabilitation Facility | 4851 Stacy Ann Dr Nw, Bemidji, MN 56601 | 2020-02-17 |
| 1366093841 | Vickie Lynn Matthews | Technician | 1018 Miles Ave Se, Bemidji, MN 56601 | 2019-09-25 |
| 1518443530 | Lindsey Marie Whiting | Registered Nurse | 1300 Anne St, Bemidji, MN 56601 | 2018-07-12 |
| 1801257662 | Meghan Zigrida Paquette | Registered Nurse | 6055 161st Street Nw, Cass Lake, MN 56601 | 2016-03-08 |
| 1144686106 | Northwest Indian Oic | Home Health | 1819 Bemidji Ave N Ste 1, Bemidji, MN 56601 | 2016-01-06 |
| 1831560424 | Laura Hansen, Msw, Licsw Counseling Services, Inc. | Social Worker | 403 4th Street Ne, Suite 110, Bemidji, MN 56601 | 2015-10-08 |
| 1679949028 | Grand St. Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 2312 Bemidji Ave North, Bemidji, MN 56601 | 2015-08-19 |
| 1255717617 | Mary S. Salter, Md Psc | Internal Medicine | 514 Beltrami Ave Nw Suite 102, Bemidji, MN 56601 | 2015-08-07 |
| 1225420615 | Cristin Evans | Counselor | 403 4th Street, Suite 300, Bemidji, MN 56601 | 2015-02-23 |
| 1619367919 | Angela Krom Fournier | Psychologist | 16150 Golden Eagle Court Nw, Eagle Vista Equine Center Inc., Bemidji, MN 56601 | 2015-01-26 |
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| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326552944 | Great Western Medical Group Pllc | Orthopaedic Surgery | 118 Paul Bunyan Dr S, Bemidji, MN 56601-3236 | 2017-11-17 |
| 1265875405 | Mitchell Wyffels | Orthopaedic Surgery | 1300 Anne St Nw, Bemidji, MN 56601 | 2013-04-08 |
| 1114070182 | Jason Joseph Caron | Orthopaedic Surgery | 3807 Greenleaf Ave Nw, Bemidji, MN 56601-5817 | 2007-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053955385 | Summit Orthopedics Ltd | Orthopaedic Surgery | 4360 12th Ave E, Shakopee, MN 55379-1955 | 2019-10-30 |
| 1639631526 | Multiple Care of Mn, LLC | Orthopaedic Surgery | 8500 Normandale Lake Blvd Ste 350, Bloomington, MN 55437-3805 | 2019-04-01 |
| 1073933719 | Nicholas Adam Lesmeister | Orthopaedic Surgery | 2014 South 6th Street, Brainerd, MN 56401 | 2014-04-21 |
| 1477971174 | Thomas Jay Kaiser | Orthopaedic Surgery | 35 State Ave Ste 1, Faribault, MN 55021-6369 | 2014-03-31 |
| 1073876876 | Daniel Borgen | Orthopaedic Surgery | 1811 Pennsylvania Ave N, Golden Valley, MN 55427-4015 | 2012-06-18 |
| 1194019729 | John Allen Wilson Jr. | Orthopaedic Surgery | 7327 Rogers Point Rd Nw, Walker, MN 56484-2523 | 2011-05-31 |
| 1952693749 | Kurt Joseph Duncan | Orthopaedic Surgery | 8650 Hudson Blvd N Ste 100, Lake Elmo, MN 55042-8416 | 2011-05-11 |
| 1407155054 | Paul T. Wicklund, M.d., P.a. | Orthopaedic Surgery | 6545 France Ave S Ste 363, Edina, MN 55435-2121 | 2011-03-22 |
| 1861712861 | Wayne William Thompson | Orthopaedic Surgery | 1651 Saunders Ave, Saint Paul, MN 55116-2430 | 2010-06-02 |
| 1124357512 | William Jarvis Busby | Orthopaedic Surgery | 501 Holly Cir, Wayzata, MN 55391-1369 | 2009-12-14 |
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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.