Healthcare Provider Details

I. General information

NPI: 1932159860
Provider Name (Legal Business Name): MARKUS M. FITZEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 MILO B. SAMPSON LANE
BLOOMINGTON IN
47408-1398
US

IV. Provider business mailing address

2425 MILO B. SAMPSON LANE
BLOOMINGTON IN
47408-1398
US

V. Phone/Fax

Practice location:
  • Phone: 812-349-5074
  • Fax: 812-349-5130
Mailing address:
  • Phone: 812-349-5074
  • Fax: 812-349-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMA220699
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01062683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: