Healthcare Provider Details

I. General information

NPI: 1104809227
Provider Name (Legal Business Name): RICHARD R FITZSIMONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10733 W. 165TH ST.
ORLAND PARK IL
60467-8713
US

IV. Provider business mailing address

10733 W. 165TH ST.
ORLAND PARK IL
60467-8713
US

V. Phone/Fax

Practice location:
  • Phone: 708-957-7468
  • Fax: 708-957-7471
Mailing address:
  • Phone: 708-957-7468
  • Fax: 708-957-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number36065461
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: