MEDICARE: MATTHEW FITZPATRICK 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	2085R0202X	Diagnostic Radiology Physician	01060455A	IN
2	2085R0204X	Vascular & Interventional Radiology Physician	01060455A	IN

General Provider Information

NPI Number	:	1740273077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW FITZPATRICK M.D.

Provider Business Mailing Address
First Line	:	9201 CALUMET AVE
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-2807
Country	:	US
Telephone Number	:	219-836-2022
Fax Number	:	219-836-0034

Provider Business Practice Location Address
First Line	:	901 MACARTHUR BLVD
Second Line	:	RADIOLOGY DEPARTMENT
City	:	MUNSTER
State	:	IN
Zip	:	46321-2901
Country	:	US
Telephone Number	:	219-836-4569
Fax Number	:

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/18/2008

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