MEDICARE: MICHAEL C FITZPATRICK MD

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	174400000X	Specialist	F7754	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0044HR	OTHER	TX	BCBC PROVIDER NUMBER

General Provider Information

NPI Number	:	1346243151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C FITZPATRICK MD

Provider Business Mailing Address
First Line	:	PO BOX 580
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-0580
Country	:	US
Telephone Number	:	972-991-9950
Fax Number	:	972-991-4026

Provider Business Practice Location Address
First Line	:	1341 W MOCKINGBIRD LN
Second Line	:	MOCKINGBIRD TOWERS, STE 710E
City	:	DALLAS
State	:	TX
Zip	:	75247-6913
Country	:	US
Telephone Number	:	214-217-7520
Fax Number	:	214-217-7530

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/12/2008

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