Provider Demographics
NPI:1689617672
Name:FITZSIMMONS, MARGARET S (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:S
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:S
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:156 W MUSKEGON DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3069
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:600 VITALITY DR
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1273
Practice Address - Country:US
Practice Address - Phone:317-477-6400
Practice Address - Fax:317-477-6409
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036120A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100466580Medicaid
INE15897Medicare UPIN
IN100466580Medicaid
INM400016875Medicare PIN
INP00859173Medicare PIN