MARK R FITZSIMMONS (NPI# 1639284706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639284706 |
| Entity Type | Individual |
| Full Name | MARK R FITZSIMMONS |
| Credential | MD |
| Practice Address |
1475 W Grand Ave Port Washington WI 53074 |
| Mailing Address |
3003 W Good Hope Rd Milwaukee WI 53209-2042 |
| Practice Telephone | 2622685100 |
| Practice Fax Number | 2622685118 |
| Mailing Telephone | 4143523100 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2009-09-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 33627 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 31986200 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235591140 | Mark Fitzsimmons | Counselor | 204 Nantucket Ave, Victoria, TX 77904-2504 | 2016-03-22 |
| Street Address |
1475 W GRAND AVE |
| City | PORT WASHINGTON |
| State | WI |
| Zip Code | 53074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528002904 | Bryan Canfield | Physical Therapist | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2006-06-15 |
| 1396239182 | Breanne N Geipel | Physical Therapist | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2018-06-15 |
| 1558742726 | Christopher M Eernisse | Family Medicine | 1475 W Grand Ave, Port Washington, WI 53074 | 2015-06-14 |
| 1861741365 | Alesha J Ewig | Physician Assistant | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2012-08-30 |
| 1720303670 | Anna V Kleyman | Family Medicine | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2010-04-05 |
| 1619108537 | Aurora Advanced Healthcare Inc. | Durable Medical Equipment & Medical Supplies | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2009-07-28 |
| 1306953278 | Scot A Wilfong | Family Medicine | 1475 W Grand Ave, Port Washington, WI 53074 | 2006-08-24 |
| 1851408231 | Tedmond R O'reilly | Family Medicine | 1475 W Grand Ave, Port Washington, WI 53074 | 2006-08-23 |
| 1306870522 | Aurora Pharmacy Inc | Pharmacy | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962045864 | Heather Kay Brede | Technician | 857 Ashley Avenue, Port Washington, WI 53074 | 2019-10-23 |
| 1780062034 | Amanda Zitzer | Specialist/Technologist | 1037 S Spring Street, Apt 257, Port Washington, WI 53074 | 2015-05-07 |
| 1639507643 | Kelly Mulder | Occupational Therapy Assistant | 138 E Prospect St, Port Washington, WI 53074 | 2013-10-30 |
| 1235310921 | Susan Ann Dobberpuhl | Occupational Therapist | 306 N Sprint St, Port Washington, WI 53074 | 2007-11-21 |
| 1245444736 | Lee B Raffel | Social Worker | 3632 E Norport Drive, Port Washington, WI 53074 | 2007-05-10 |
| 1023143708 | Joshua E Leute | Dentist | 1317 West Grand Avenue, Port Washington, WI 53074 | 2007-02-22 |
| 1578633806 | Robert Andrew Kortsch | Dentist | 457 W Grand Ave, Port Washington, WI 53074 | 2006-11-08 |
| 1538256409 | Daniel P Witkowski | Dentist | 1612 N Wisconsin St, Port Washington, WI 53074 | 2006-10-10 |
| 1477584878 | Francine L Cosner | Obstetrics & Gynecology | 1777 W Grand Avenue, Port Washington, WI 53074 | 2006-07-05 |
| 1013953926 | Port Washington Podiatry Inc | Podiatrist | 1317 W Grand Avenue, Port Washington Podiatry, Port Washington, WI 53074 | 2006-06-20 |
| Find all providers in zip 53074 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679801344 | Raymond J. Voulo | Family Medicine | 71 Longview Rd, Port Washington, NY 11050-3039 | 2009-11-18 |
| 1437483120 | Danielle D Roberts | Family Medicine | 403-1 Main Street, Port Washington, NY 11040 | 2009-09-28 |
| 1790966968 | Scott Rex, Md, LLC. | Family Medicine | 620 Port Washington Blvd, Port Washington, NY 11050-3714 | 2007-11-16 |
| 1427188473 | Premier Physician Services | Family Medicine | 14 Vanderventer Ave Ste 138, Suite 130-138, Port Washington, NY 11050-3737 | 2007-03-07 |
| 1457493694 | Gabrielle C. Young-lyon | Family Medicine | 23 Dolphin Grn Apt E2b, Port Washington, NY 11050-3161 | 2007-02-13 |
| 1750429007 | Raymond Webster | Family Medicine | 2 Hampton Ct, Port Washington, NY 11050-3021 | 2007-02-01 |
| 1649318981 | Raymond A Webster | Family Medicine | 2 Cow Neck Rd, Port Washington, NY 11050-1712 | 2007-02-01 |
| 1760568851 | Gerald Zupnick | Family Medicine | 15 Hampton Rd, Port Washington, NY 11050-3008 | 2006-10-31 |
| 1801819180 | Farzad Tabibzadeh | Family Medicine | 22 S Maryland Ave, Port Washington, NY 11050-2913 | 2006-07-26 |
| 1053375246 | Scott L Rex | Family Medicine | 6 Bernard St, Port Washington, NY 11050-2902 | 2006-04-14 |
| Find all providers in PORT WASHINGTON | ||||
| City | PORT WASHINGTON |
| Zip Code | 53074 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.