MEDICARE: DR. RUCHI MISHRA FITZGERALD M.D.

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	207Q00000X	Family Medicine Physician	11751	MT
2	208600000X	Surgery Physician	A94124	CA
3	207QA0401X	Addiction Medicine (Family Medicine) Physician	036150211	IL

General Provider Information

NPI Number	:	1720060072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUCHI MISHRA FITZGERALD M.D.

Provider Business Mailing Address
First Line	:	600 S PAULINA ST STE 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-942-5000
Fax Number	:	312-942-5727

Provider Business Practice Location Address
First Line	:	600 S PAULINA ST STE 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-942-5000
Fax Number	:	312-942-5727

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	08/27/2019

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