Provider Demographics
NPI:1073336970
Name:COFIE, FITZGERALD CONRAD
Entity type:Individual
Prefix:
First Name:FITZGERALD
Middle Name:CONRAD
Last Name:COFIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 55TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1551
Mailing Address - Country:US
Mailing Address - Phone:515-771-2340
Mailing Address - Fax:
Practice Address - Street 1:1914 55TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1551
Practice Address - Country:US
Practice Address - Phone:515-771-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health