Individual provider Active NPI

Mary P Fitzgerald, MD

  • Obstetrics & Gynecology Physician
  • Hines, IL
National Provider Identifier
1245207083
Registry record updated Apr 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
36094701 Issued in IL
Practice address
5500 S 5TH Avenue
BLDG 1, Room 320
Hines, IL 60141
Phone
(708) 202-2036
Fax
(708) 202-2180
NPI assigned
Mar 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 36094701 IL Primary
Urology Physician 208800000X 36094701 IL

Addresses

Primary practice location

5500 S 5TH Avenue
BLDG 1, Room 320
Hines, IL 60141

Mailing address

5500 S 5TH Avenue
BLDG 1, Room 320
Hines, IL 60141
Phone (708) 202-2036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36094701ILMDObstetrics & Gynecology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333929600000",
    "number": "1245207083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 S 5TH AVENUE",
            "address_2": "BLDG 1, ROOM 320",
            "city": "HINES",
            "state": "IL",
            "postal_code": "60141",
            "telephone_number": "708-202-2036",
            "fax_number": "708-202-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 S 5TH AVENUE",
            "address_2": "BLDG 1, ROOM 320",
            "city": "HINES",
            "state": "IL",
            "postal_code": "60141",
            "telephone_number": "708-202-2036",
            "fax_number": "708-202-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "MARY",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2012-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "36094701",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "36094701",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.