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1770576977

NPI Code Detail

MEDICARE: TODD W VITAZ MD

MEDICARE: TODD W VITAZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	4301101710	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	196290EEEE	OTHER	IN	MEDICARE - IN - NNIKY
9	P00711479	OTHER	KY	RAILROAD KY MEDICARE - NNIKY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3637830	OTHER	KY	CIGNA - NNIKY
2	047131	OTHER	KY	SIHO - NNIKY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000023035G	OTHER	KY	HUMANA - NNIKY
6	000000604896	OTHER	KY	ANTHEM - NNIKY
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	3694171000	OTHER	KY	PASSPORT ADVTG - NNIKY

General Provider Information

NPI Number	:	1770576977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD W VITAZ MD

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 MICHIGAN ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2531
Country	:	US
Telephone Number	:	616-267-7900
Fax Number	:	616-267-7901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	12/10/2024

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Directions to “ TODD W VITAZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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