Healthcare Provider Details

I. General information

NPI: 1548298912
Provider Name (Legal Business Name): MICHAEL W CHITWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 TRAFALGAR SQ
TRAFALGAR IN
46181-9515
US

IV. Provider business mailing address

14 TRAFALGAR SQ
TRAFALGAR IN
46181-9515
US

V. Phone/Fax

Practice location:
  • Phone: 317-412-9190
  • Fax: 317-878-2302
Mailing address:
  • Phone: 317-412-9190
  • Fax: 317-878-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01032024A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: