Healthcare Provider Details

I. General information

NPI: 1972547883
Provider Name (Legal Business Name): MICHAEL JON KITTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 MAIN ST
MARLETTE MI
48453-1141
US

IV. Provider business mailing address

13695 TIMBERWYCK DR
SHELBY TOWNSHIP MI
48315-2410
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-4055
  • Fax:
Mailing address:
  • Phone: 586-945-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101013536
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: