Provider Demographics
NPI:1871976605
Name:FETTEN, KATHARINA (MD)
Entity type:Individual
Prefix:MS
First Name:KATHARINA
Middle Name:
Last Name:FETTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N HALL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1339
Mailing Address - Country:US
Mailing Address - Phone:469-800-7760
Mailing Address - Fax:469-800-7760
Practice Address - Street 1:621 N HALL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1339
Practice Address - Country:US
Practice Address - Phone:469-800-7760
Practice Address - Fax:469-800-7770
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7475208600000X
390200000X
TXU2484208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program