Healthcare Provider Details

I. General information

NPI: 1871988469
Provider Name (Legal Business Name): MICHAEL JOHN FITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 08/20/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

6220 PLUM THICKET RD
OKLAHOMA CITY OK
73162-3423
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2952
  • Fax:
Mailing address:
  • Phone: 405-323-1729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101021945
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7246
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: