=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487055018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL J ZITER MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2014
-----------------------------------------------------
Last Update Date | 09/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 N MILL ST
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49670-5009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-386-5450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 939
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49670-0939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-452-0800
-----------------------------------------------------
Fax | 810-503-4335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL J ZITER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 231-386-5450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | MZ037963
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------