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General NPI Number Information
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NPI Number | 1396750600
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Entity Type | Individual
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Provider Name | COLLEEN FITZGERALD MD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE BLD 103/1014
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-2170
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Fax | 708-216-2171
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Provider Business Mailing Address
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Address Line | 2160 S 1ST AVE BLD 103/1014
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-2170
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Fax | 708-216-2171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036-102356
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036-102356
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License Number State | IL
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