Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11751 | MT |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036150211 | IL |
N | 208200000X | Surgeon | A94124 | CA |
N | 208600000X | Surgeon | A94124 | CA |
NPI | 1720060072 |
---|---|
Provider Name | Dr. Ruchi Mishra Fitzgerald |
First Address | Chicago, IL 60612-3806 |
Second Address | Chicago, IL 60612-3806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 27/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |