Individual
PHILIP D FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 AUDUBON PLAZA DR, LL 2, LOUISVILLE, KY 40217-1319
(502) 636-8095
(502) 636-8097
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25883
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000050938
ANTHEM / NCMA
KY
01
—
000023029B
HUMANA / NCMA
KY
01
—
008894
SIHO / NCMA
KY
01
—
1054792
PASSPORT / NCMA
KY
01
—
110132054
RAILROAD MEDICARE
KY
05
—
200532240
—
IN
01
—
2433726000
PASSPORT ADVANTAGE / NCMA
—
05
—
64258833
—
KY
Enumeration date
04/18/2006
Last updated
01/12/2021
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