Provider Demographics
NPI:1356350938
Name:FABRIZIO, PATRICK L (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:FABRIZIO
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3525
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47734-3525
Mailing Address - Country:US
Mailing Address - Phone:616-486-5750
Mailing Address - Fax:616-486-5785
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-1830
Practice Address - Fax:616-391-1286
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010655392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI920005690OtherRAILROAD MEDICARE
MI4236100Medicaid
G36324Medicare UPIN