Fitzgerald, Kevin Edward

Fitzgerald, Kevin Edward is an individual health care provider with primary practice located at 4100 Lake Dr Se Ste 305, Grand Rapids MI 49546. He recently has only one registered license in Allopathic & Osteopathic Physicians / Interventional Pain Medicine, which is considered as his primary health care specialty. Fitzgerald, Kevin Edward can be contacted via phone (616) 285-1377.

Contact Information

Primary practice address
4100 Lake Dr Se Ste 305 Grand Rapids MI 49546
Phone: (616) 285-1377
Fax: (616) 285-1006
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 4301044533 Michigan

Profile Details

NPI number 1144281080
LBN Legal business name Fitzgerald, Kevin Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2006
Last updated Nov 18th, 2008 - about 16 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 1144281080 NPPES
Michigan MEDICAID 4532350-10
Michigan Other 5648777
Michigan MEDICAID 4592438-10
Michigan Other 23113
Michigan MEDICAID 4507437-10
Michigan Other 550410072
Michigan Other P00057547
Michigan Other 7000144071
Michigan Other 4642669

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