Provider Demographics
NPI:1669437166
Name:FITZGERALD, PHILIP D (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:LL 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-8095
Practice Address - Fax:502-636-8097
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY25883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1054792OtherPASSPORT / NCMA
KY110132054OtherRAILROAD MEDICARE
2433726000OtherPASSPORT ADVANTAGE / NCMA
KY008894OtherSIHO / NCMA
KY64258833Medicaid
KY00000050938OtherANTHEM / NCMA
KY000023029BOtherHUMANA / NCMA
IN200532240Medicaid
2433726000OtherPASSPORT ADVANTAGE / NCMA
KYE18257Medicare UPIN