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General NPI Number Information
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NPI Number | 1609955400
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Entity Type | Individual
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Provider Name | STEPHANIE LYNNE FITZGERALD D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1293 E PARKDALE AVE SUITE 1200A
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City | MANISTEE
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State | MI
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Zip | 49660-8904
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Country | US
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Telephone | 231-398-1550
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Fax | 231-398-1691
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Provider Business Mailing Address
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Address Line | 1293 E PARKDALE AVE SUITE 1200A
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City | MANISTEE
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State | MI
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Zip | 49660-8904
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Country | US
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Telephone | 231-398-1550
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Fax | 231-398-1691
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5101012161
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License Number State | MI
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