Individual
JOHN BIREN-FETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1740 W TAYLOR ST # MC931, CHICAGO, IL 60612-7232
(312) 996-0235
Mailing address
1310 LAS TABLAS RD STE 103, TEMPLETON, CA 93465-9746
(805) 461-7080
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R3011
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
20A22502
CA
390200000X
Student in an Organized Health Care Education/Training Program
125.074472
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255821120
—
AZ
Enumeration date
05/15/2018
Last updated
08/12/2024
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