Individual ProviderDaniel FechtnerPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansPractice Address235 Wealthy St SE Ste 100, Grand Rapids, MI 49503-5229(616) 840-8719PECOS EnrollmentBased on the most recent information from CMS, provider Daniel Fechtner is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:10 AM.Profile DetailsProvider ID1467440487Provider TypeIndividualFull NameFechtner, DanielCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date10/13/2005Last Updated3/12/2025Contact InformationPractice LocationPractice Address235 Wealthy St SE Ste 100, Grand Rapids, MI 49503-5229Phone(616) 840-8719Fax(616) 840-9637Mailing LocationMailing Address235 Wealthy St SE Ste 100, Grand Rapids, MI 49503-5229Phone(616) 840-8719Fax(616) 840-9637Provider TaxonomiesCodeDescriptionLicenseCode208100000XPrimaryDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense4301102208MichiganCode208100000XDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense25MA05407200New JerseyCode208100000XDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense165156New YorkProvider IdentifiersIDDescriptionIssuerID0004405DescriptionMedicaidIssuerUnlistedNew Jersey