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General NPI Number Information
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NPI Number | 1568640191
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Entity Type | Organization
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Legal Business Name | MICHAEL L GITTLESON, DPM
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 5454 WISCONSIN AVE #1250
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City | CHEVY CHASE
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State | MD
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Zip | 20815
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Country | US
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Telephone | 301-986-4900
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Fax | 301-986-0002
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Provider Business Mailing Address
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Address Line | 5454 WISCONSIN AVE #1250
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City | CHEVY CHASE
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State | MD
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Zip | 20815
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Country | US
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Telephone | 301-986-4900
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Fax | 301-986-0002
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL LLOYD GITTLESON
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Credential | DPM
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Telephone | 301-986-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000918
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License Number State | MD
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