Provider Demographics
NPI:1518402577
Name:FITZPATRICK, MATTHEW ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:FITZPATRICK
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Gender:
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:109 MICHIGAN ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3795
Mailing Address - Country:US
Mailing Address - Phone:888-981-2263
Mailing Address - Fax:
Practice Address - Street 1:109 MICHIGAN ST NW STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3795
Practice Address - Country:US
Practice Address - Phone:888-981-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant