Healthcare Provider Details

I. General information

NPI: 1053382275
Provider Name (Legal Business Name): MICAHEL L FITZPATRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E FRANKLIN ST
KENTON OH
43326-2020
US

IV. Provider business mailing address

7507 ANNIN ST
HOLLAND OH
43528-9550
US

V. Phone/Fax

Practice location:
  • Phone: 419-675-8328
  • Fax:
Mailing address:
  • Phone: 419-866-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35052675F
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35052675F
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: