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General NPI Number Information
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NPI Number | 1144683301
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Entity Type | Organization
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Legal Business Name | MOBILE PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2308 ROOSEVELT RD
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City | VALPARAISO
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State | IN
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Zip | 46383-2773
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Country | US
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Telephone | 219-464-9588
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Fax | 219-462-4470
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Provider Business Mailing Address
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Address Line | 515 SILHAVY RD
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City | VALPARAISO
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State | IN
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Zip | 46383-4452
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Country | US
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Telephone | 219-464-9588
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Fax | 219-462-4470
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY FITZGERALD
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Credential | D.P.M.
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Telephone | 219-464-9588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07001158A
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License Number State | IN
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