MEDICARE: MR. MICHAEL FITZGERALD L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	8691	CA

General Provider Information

NPI Number	:	1043753593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL FITZGERALD L.AC.

Provider Business Mailing Address
First Line	:	533 EVERETT ST
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3235
Country	:	US
Telephone Number	:	510-549-9905
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 WEST ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1927
Country	:	US
Telephone Number	:	510-549-9905
Fax Number	:	844-270-2102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	01/28/2025

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