Provider Demographics
NPI:1972522415
Name:AURORA WOMENS HEALTH CARE
Entity type:Organization
Organization Name:AURORA WOMENS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-746-7747
Mailing Address - Street 1:2490 S WOODWORTH LP
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7405
Mailing Address - Country:US
Mailing Address - Phone:907-746-7747
Mailing Address - Fax:907-746-7731
Practice Address - Street 1:2490 S WOODWORTH LP
Practice Address - Street 2:SUITE 200
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-746-7747
Practice Address - Fax:907-746-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD67611Medicaid
AKG22364Medicare UPIN
AKMD67611Medicaid