Healthcare Provider Details

I. General information

NPI: 1629024385
Provider Name (Legal Business Name): MICHAEL ELLIS HITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W FOUNTAINHEAD PKWY SUITE 295
TEMPE AZ
85282-1868
US

IV. Provider business mailing address

808 E CORTE ORO
PHOENIX AZ
85020-3773
US

V. Phone/Fax

Practice location:
  • Phone: 866-495-6738
  • Fax: 800-398-6182
Mailing address:
  • Phone: 602-549-2759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: