Healthcare Provider Details

I. General information

NPI: 1356350938
Provider Name (Legal Business Name): PATRICK L FABRIZIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

PO BOX 3525
EVANSVILLE IN
47734-3525
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-1830
  • Fax: 616-391-1286
Mailing address:
  • Phone: 616-486-5750
  • Fax: 616-486-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301065539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: