MEDICARE: MICHELE FITZGERALD LM CPM

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	176B00000X	Midwife	96151	TX

General Provider Information

NPI Number	:	1356524979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE FITZGERALD LM CPM

Provider Business Mailing Address
First Line	:	511 E 43RD ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-3908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 E 43RD ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-3908
Country	:	US
Telephone Number	:	512-420-0971
Fax Number	:

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

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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