MEDICARE: GREGORY BERNARD 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	207W00000X	Ophthalmology Physician	4301070156	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7532354	OTHER	MI	AETNA
2	H54083	OTHER	MI	PPOM UPIN
3	14377	OTHER	MI	M-CARE
4	G5031F	OTHER	MI	BLUE CARE NETWORK GROUP #
5	180F321870	OTHER	MI	BLUE CROSS GROUP
6	H50483	OTHER		HAP
7	135378	OTHER	MI	CARE CHOICES ID #
8	H50483	OTHER	MI	HAP UPIN

General Provider Information

NPI Number	:	1992701452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY BERNARD FITZGERALD M.D.

Provider Business Mailing Address
First Line	:	600 S ADAMS RD
Second Line	:	STE 200
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6863
Country	:	US
Telephone Number	:	248-646-3733
Fax Number	:	248-642-2566

Provider Business Practice Location Address
First Line	:	600 S ADAMS RD
Second Line	:	STE 200
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6863
Country	:	US
Telephone Number	:	248-646-3733
Fax Number	:	248-642-2566

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/17/2021

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Directions to “ GREGORY BERNARD FITZGERALD M.D.” Practice Location

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