Individual
COLLEEN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, BLD 103/1014, MAYWOOD, IL 60153-3328
(708) 216-2170
(708) 216-2171
Mailing address
2160 S 1ST AVE, BLD 103/1014, MAYWOOD, IL 60153-3328
(708) 216-2170
(708) 216-2171
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-102356
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
036-102356
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102356
—
IL
01
—
P00051933
RAILROAD MEDICARE
IL
01
—
P00051934
RR MEDICARE
IL
Enumeration date
07/29/2006
Last updated
01/17/2013
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