Individual
DR. LARRY W FITZSIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7660 PINE PARK DR SE, GRAND RAPIDS, MI 49546-9130
(616) 975-9744
Mailing address
7660 PINE PARK DR SE, GRAND RAPIDS, MI 49546-9130
(616) 975-9744
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301030647
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LF030647
MICHIGAN ID NUMBER
MI
Enumeration date
05/29/2012
Last updated
05/29/2012
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