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NPI Code Detail

MEDICARE: DR. JACQUELINE M FITZGERALD D.O.

MEDICARE: DR. JACQUELINE M FITZGERALD D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician5101009215MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205862455
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE M FITZGERALD D.O.
Provider Business Mailing Address
First Line : 11745 US HIGHWAY 23 S
Second Line :
City : OSSINEKE
State : MI
Zip : 49766-9582
Country : US
Telephone Number : 989-471-2156
Fax Number : 989-471-5257
Provider Business Practice Location Address
First Line : 11745 US HIGHWAY 23 S
Second Line :
City : OSSINEKE
State : MI
Zip : 49766-9582
Country : US
Telephone Number : 989-471-2156
Fax Number : 989-471-5257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 02/02/2021

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