Provider Demographics
NPI:1164456786
Name:PITT, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PITT
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL-1766DP2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL300059298OtherRAILROAD MEDICARE
ALE28390OtherVIVA
AL009932064Medicaid
AL009980350Medicaid
AL051534314OtherBLUE CROSS
AL000085063OtherBLUE CROSS
MS00124784OtherMISSISSIPPI MEDICAID
AL051513005OtherBLUE CROSS
AL009936977Medicaid
MS0116890OtherMISSISSIPPI MEDICAID
AL051505680OtherBLUE CROSS
AL000085063Medicaid
AL009932036Medicaid
AL051506080OtherBLUE CROSS
AL300059298OtherRAILROAD MEDICARE