Provider Demographics
NPI:1861408064
Name:FITZPATRICK, COLLINS (MD)
Entity type:Individual
Prefix:
First Name:COLLINS
Middle Name:
Last Name:FITZPATRICK
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 1:5601 S COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4875
Mailing Address - Country:US
Mailing Address - Phone:708-342-6927
Mailing Address - Fax:
Practice Address - Street 1:5601 S COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4875
Practice Address - Country:US
Practice Address - Phone:630-286-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104695208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00011111OtherRAILROAD MEDICARE
ILP00011117OtherRAILROAD MEDICARE
IL036104695Medicaid
ILL98173Medicare PIN
IL036104695Medicaid
H81990Medicare UPIN
ILL99200Medicare PIN