Fitzgerald, Colleen

Fitzgerald, Colleen is an individual health care provider with primary practice located at 2160 S 1St Ave Bld 103/1014, Maywood IL 60153-3328. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is her primary health care specialty. Fitzgerald, Colleen can be contacted via phone (708) 216-2170.

Contact Information

Primary practice address
2160 S 1St Ave Bld 103/1014 Maywood IL 60153-3328
Phone: (708) 216-2170
Fax: (708) 216-2171
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 036-102356 Illinois
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 036-102356 Illinois

Profile Details

NPI number 1396750600
LBN Legal business name Fitzgerald, Colleen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2006
Last updated Jan 17th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396750600 NPPES
Illinois Other P00051933 RAILROAD MEDICARE
Illinois Other P00051934 RAILROAD MEDICARE
Illinois MEDICAID 036102356 RAILROAD MEDICARE

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