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General NPI Number Information
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NPI Number | 1518393800
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Entity Type | Organization
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Legal Business Name | JOHN KITZMILLER M.D. PC
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1455 S LAPEER RD STE 200
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City | LAKE ORION
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State | MI
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Zip | 48360-1468
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Country | US
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Telephone | 248-693-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 S LAPEER RD STE 200
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City | LAKE ORION
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State | MI
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Zip | 48360-1468
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Country | US
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Telephone | 248-693-4000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN WILLIAM KITZMILLER
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Credential | M.D.
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Telephone | 248-693-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 430136695
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License Number State | MI
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