Organization
MOBILE PHYSICIANS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY FITZGERALD D.P.M. (OWNER)
(219) 464-9588
Entity
Organization
Contact information
Practice address
2308 ROOSEVELT RD, VALPARAISO, IN 46383-2773
(219) 464-9588
(219) 462-4470
Mailing address
515 SILHAVY RD, VALPARAISO, IN 46383-4452
(219) 464-9588
(219) 462-4470
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07001158A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07001158A
LICENSE
IN
01
—
07001158B
CSR
IN
01
—
1265759054
INDIVIDUAL NPI
—
05
—
201166760A
—
IN
01
—
P01563138
RR MEDICARE
—
Enumeration date
04/04/2016
Last updated
03/07/2023
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