Healthcare Provider Details

I. General information

NPI: 1760493472
Provider Name (Legal Business Name): KATHERINE J PITUS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118000 E TWELVE MILE RD ER DEPARTMENT
WARREN MI
48093
US

IV. Provider business mailing address

PO BOX 67000 DEPT 285301
DETROIT MI
48267-2853
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5028
  • Fax:
Mailing address:
  • Phone: 800-540-8739
  • Fax: 616-975-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberKP011465
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101011465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: