Provider Demographics
NPI:1942496104
Name:FITZGERALD, CATHERINE M (RD, MA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:RD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S INDUSTRIAL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANN ARBOR
Mailing Address - State:ID
Mailing Address - Zip Code:48104-7100
Mailing Address - Country:US
Mailing Address - Phone:734-975-3060
Mailing Address - Fax:
Practice Address - Street 1:2850 S INDUSTRIAL HWY
Practice Address - Street 2:SUITE 600
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6796
Practice Address - Country:US
Practice Address - Phone:734-975-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI817490133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered