Individual
JASON TROY FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12750 ST FRANCIS DR STE 320, CROWN POINT, IN 46307-0264
(219) 662-0077
(219) 662-9496
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01076416A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01076416A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
11738
MT
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
DR.0056684
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201347360
—
IN
Enumeration date
11/10/2005
Last updated
01/15/2024
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