Basic Information
| Provider Information | |||||||||
| NPI: | 1548210867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | SHAWN | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FITZPATRICK | ||||||||
| OtherFirstName: | MIKE | ||||||||
| OtherMiddleName: | SHAWN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 320 WHITTINGTON PKWY STE 301 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908782 | ||||||||
| FaxNumber: | 5024590923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 MISSOURI AVE | ||||||||
| Address2: | STE 2547 | ||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471303725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122832183 | ||||||||
| FaxNumber: | 8122832236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 01038527 | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.