Provider Demographics
NPI:1932159860
Name:FITZEK, MARKUS M (MD)
Entity Type:Individual
Prefix:
First Name:MARKUS
Middle Name:M
Last Name:FITZEK
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 1:2425 MILO B. SAMPSON LANE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1398
Mailing Address - Country:US
Mailing Address - Phone:812-349-5074
Mailing Address - Fax:812-349-5130
Practice Address - Street 1:2425 MILO B. SAMPSON LANE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1398
Practice Address - Country:US
Practice Address - Phone:812-349-5074
Practice Address - Fax:812-349-5130
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2206992085R0001X
IN01062683A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0036324OtherNHP OF MASS
MA2071011Medicaid
2400030OtherUHC
IN200860660Medicaid
J27948OtherBLUE CROSS BLUE SHIELD
I09302Medicare UPIN
IN201140EMedicare PIN
0036324OtherNHP OF MASS