Individual
EVAN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13320 NORTH BLVD, VICKSBURG, MI 49097-1514
(269) 649-2012
Mailing address
13320 NORTH BLVD, VICKSBURG, MI 49097-1514
(269) 649-2012
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0116029765
VA
207Q00000X
Family Medicine Physician
Primary
4301500376
MI
Other
Enumeration date
06/27/2016
Last updated
11/27/2023
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