Provider Demographics
NPI:1003801499
Name:BITZER, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:BITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:904 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2193
Mailing Address - Country:US
Mailing Address - Phone:217-540-2350
Mailing Address - Fax:217-347-2323
Practice Address - Street 1:904 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2193
Practice Address - Country:US
Practice Address - Phone:217-540-2350
Practice Address - Fax:217-347-2323
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036081888208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081888Medicaid
F30160Medicare UPIN
IL036081888Medicaid