Individual
KELLY FITZGIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
37595 7 MILE RD, SUITE 220, LIVONIA, MI 48152-1003
(734) 432-7591
(734) 853-5698
Mailing address
33523 8 MILE RD, STE M2, LIVONIA, MI 48152-4119
(734) 432-7591
(734) 853-5698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301059573
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4619139
—
MI
Enumeration date
03/01/2006
Last updated
01/21/2020
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