Provider Demographics
NPI:1326060609
Name:KITZMILLER, JOHN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:KITZMILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:559 E ALISAL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2516
Mailing Address - Country:US
Mailing Address - Phone:831-769-1304
Mailing Address - Fax:831-757-0291
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:BLDG. 200, SUITE 105
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-769-8660
Practice Address - Fax:831-769-8655
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC28160207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-6000524OtherCOUNTY OF MONTEREY EIN
CAD08849Medicare UPIN
CAZZZ02040ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY GROUP