Provider Demographics
NPI:1033154067
Name:LITWILLER, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:LITWILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-3834
Mailing Address - Fax:
Practice Address - Street 1:2620 KESSLER BOULEVARD EAST DR
Practice Address - Street 2:STE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2890
Practice Address - Country:US
Practice Address - Phone:317-475-6200
Practice Address - Fax:317-475-6212
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010365152084P0800X
IN01036515A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100176440AMedicaid
INP00887152OtherRAILROAD MEDICARE
IN100176440AMedicaid
IN264430AAMedicare PIN
INP00887152OtherRAILROAD MEDICARE