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NPI Code Detail

MEDICARE: DR. MICHAEL GLEN FITZGERALD M.D.

MEDICARE: DR. MICHAEL GLEN 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
1174400000XSpecialist4644AK
2207V00000XObstetrics & Gynecology PhysicianG5044TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831191527
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL GLEN FITZGERALD M.D.
Provider Business Mailing Address
First Line : 777 LOWNDES HILL RD BLDG 1
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2101
Country : US
Telephone Number : 800-967-2289
Fax Number : 855-462-9736
Provider Business Practice Location Address
First Line : 520 E 6TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-4527
Country : US
Telephone Number : 800-967-2289
Fax Number : 855-462-9736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 10/03/2022

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