Healthcare Provider Details

I. General information

NPI: 1326074378
Provider Name (Legal Business Name): MICHAEL VALITUTTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SHAFFER ST STE 229
KALAMAZOO MI
49048-1647
US

IV. Provider business mailing address

5943 STADIUM DR STE 3
KALAMAZOO MI
49009-3016
US

V. Phone/Fax

Practice location:
  • Phone: 269-226-8321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101012365
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: