Provider Demographics
NPI:1407865876
Name:FITZPATRICK, AMELIA (MD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:290 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:816-524-5522
Mailing Address - Fax:816-524-4798
Practice Address - Street 1:290 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-524-5522
Practice Address - Fax:816-524-4798
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33926207RP1001X
MO2009021713207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200624140AMedicaid
MO1407865876Medicaid
MO1407865876Medicaid
KS200624140AMedicaid