Provider Demographics
NPI:1578341178
Name:FITZPATRICK, DANIEL REED
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:REED
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22305 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-1141
Mailing Address - Country:US
Mailing Address - Phone:734-624-7402
Mailing Address - Fax:
Practice Address - Street 1:22305 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173-1141
Practice Address - Country:US
Practice Address - Phone:734-624-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist