Individual
KEVIN EDWARD FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 LAKE DR SE, STE 305, GRAND RAPIDS, MI 49546
(616) 285-1377
(616) 285-1006
Mailing address
61 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4124
(616) 940-0660
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
4301044533
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23113
HEALTH PLAN OF MICHIGAN
—
05
—
4507437-10
—
MI
05
—
4532350-10
—
MI
05
—
4592438-10
—
MI
01
—
4642669
AETNA
—
01
—
550410072
BLUE CROSS BLUE SHIELD
MI
01
—
5648777
CIGNA
—
01
—
7000144071
PRIORITY HEALTH
—
01
—
P00057547
RAILROAD MEDICARE
—
Enumeration date
03/30/2006
Last updated
11/18/2008
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