Provider Demographics
NPI:1205886322
Name:FITUCH, CAMELLIA CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:CAMELLIA
Middle Name:CAROL
Last Name:FITUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAMELLIA
Other - Middle Name:CAROL
Other - Last Name:FITUCH-BEAUDOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1121 E SPRING CREEK PKWY.
Mailing Address - Street 2:STE. 110, #319
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:214-343-6663
Mailing Address - Fax:214-343-2814
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8185
Practice Address - Country:US
Practice Address - Phone:214-343-6663
Practice Address - Fax:214-343-2814
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL15752080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151255001Medicaid
8773B6Medicare ID - Type Unspecified