1689617672 NPI number — MARGARET S FITZSIMMONS MD

Table of content: MARGARET S FITZSIMMONS MD (NPI 1689617672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689617672 NPI number — MARGARET S FITZSIMMONS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZSIMMONS
Provider First Name:
MARGARET
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAXWELL
Provider Other First Name:
MARGARET
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689617672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
156 W MUSKEGON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46140-3069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-468-6270
Provider Business Mailing Address Fax Number:
317-468-6268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 VITALITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORTVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46040-1273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-477-6400
Provider Business Practice Location Address Fax Number:
317-477-6409
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01036120A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100466580 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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