Provider Demographics
NPI:1366462889
Name:FITCH, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FITCH
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 1:70 GREAT WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527
Mailing Address - Country:US
Mailing Address - Phone:907-347-6708
Mailing Address - Fax:
Practice Address - Street 1:104 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1402
Practice Address - Country:US
Practice Address - Phone:910-654-3143
Practice Address - Fax:910-654-4144
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-00024207Q00000X
SCLL27061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine