Healthcare Provider Details

I. General information

NPI: 1720635741
Provider Name (Legal Business Name): LINDSAY FITZPATRICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 13-205
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

259 E ERIE ST STE 13-205
CHICAGO IL
60611-2987
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8143
  • Fax: 312-695-4430
Mailing address:
  • Phone: 312-695-8143
  • Fax: 312-695-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085007842
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: