Basic Information
| Provider Information | |||||||||
| NPI: | 1831180306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | DENNIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 N NILES AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466171924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746471610 | ||||||||
| FaxNumber: | 5742376069 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ARCADE AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | ELKHART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465142485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743895656 | ||||||||
| FaxNumber: | 5745237891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | 46012 | WI | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207LC0200X | 01064493A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 13580 | 01 | WI | DEAN | OTHER | 34427300 | 05 | WI | MEDICAID | 46012 | 01 | WI | TOUCHPOINT | OTHER | WI01K9 | 01 | WI | JOHN DEERE | OTHER | 200986470 | 05 | IN | MEDICAID | 236040234 | 01 | IN | MEDICARE PTAN | OTHER | P00058702 | 01 | WI | RAILROAD MEDICARE | OTHER |