MEDICARE: TIMOTHY ALAN FITZGERALD DPM

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
1	213E00000X	Podiatrist	07001158A	IN
2	213E00000X	Podiatrist	07001158B	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01563138	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1265759054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ALAN FITZGERALD DPM

Provider Business Mailing Address
First Line	:	1101 CUMBERLAND XING # 262
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-2356
Country	:	US
Telephone Number	:	305-725-2524
Fax Number	:	317-564-8399

Provider Business Practice Location Address
First Line	:	1101 CUMBERLAND XING # 262
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-2356
Country	:	US
Telephone Number	:	219-299-4643
Fax Number	:	219-267-1720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	04/03/2017

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