Healthcare Provider Details

I. General information

NPI: 1447367610
Provider Name (Legal Business Name): MICHAEL JOSEPH ZITER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MILL ST
NORTHPORT MI
49670-5009
US

IV. Provider business mailing address

PO BOX 939
NORTHPORT MI
49670-0939
US

V. Phone/Fax

Practice location:
  • Phone: 231-385-7845
  • Fax:
Mailing address:
  • Phone: 231-386-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMZ037963
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: