Provider Demographics
NPI:1205022449
Name:FITZGERALD, ILJIE KIM (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:ILJIE
Middle Name:KIM
Last Name:FITZGERALD
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Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:UNIVERSITY OF CALIF SAN FRANCISCO DEPT OF PSYCHIATRY
Mailing Address - Street 2:401 PARNASSUS AVE RTP 0984
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0984
Mailing Address - Country:US
Mailing Address - Phone:415-476-7000
Mailing Address - Fax:415-502-2661
Practice Address - Street 1:UNIVERSITY OF CALIF SAN FRANCISCO DEPT OF PSYCHIATRY
Practice Address - Street 2:401 PARNASSUS AVE RTP 0984
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0984
Practice Address - Country:US
Practice Address - Phone:415-476-7000
Practice Address - Fax:415-502-2661
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
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Provider Licenses
StateLicense IDTaxonomies
CAA1009342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry