Provider Demographics
NPI:1942329370
Name:FITZGERALD, KEVIN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-525-0005
Mailing Address - Fax:859-525-8806
Practice Address - Street 1:7388 TURFWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1381
Practice Address - Country:US
Practice Address - Phone:859-525-0005
Practice Address - Fax:859-525-8806
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41887207RC0000X, 207RI0011X
OH35-091340207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200966610Medicaid
OH2844211Medicaid
KY7100043100Medicaid
OH611300608063OtherCARESOURCE
KY00954001OtherMEDICARE PTAN
KY50024705OtherPASSPORT MEDICAID
KYP00912939OtherRAILROAD MEDICARE
KY7100043100Medicaid
OH611300608063OtherCARESOURCE
KY00954001OtherMEDICARE PTAN
OHFI4233941Medicare PIN