Provider Demographics
NPI:1437130986
Name:FITZGERALD ORTHOPAEDICS, P.C.
Entity Type:Organization
Organization Name:FITZGERALD ORTHOPAEDICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:260-728-3849
Mailing Address - Street 1:203 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-1554
Mailing Address - Country:US
Mailing Address - Phone:260-728-3849
Mailing Address - Fax:260-728-3860
Practice Address - Street 1:203 N 12TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-1554
Practice Address - Country:US
Practice Address - Phone:260-728-3849
Practice Address - Fax:260-728-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004600207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1265413702OtherPROVIDER NPI NUMBER
OH=========-00OtherBWC
OH=========-00OtherBWC