Provider Demographics
NPI:1558457713
Name:BITTLES, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BITTLES
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 1:164 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1826
Mailing Address - Country:US
Mailing Address - Phone:017-352-1620
Mailing Address - Fax:
Practice Address - Street 1:164 W 13TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1826
Practice Address - Country:US
Practice Address - Phone:017-352-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22811208600000X
IN01044969A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NED03616OtherBCBS OF NEBRASKA
NE242893OtherMIDLANDS CHOICE
NE1700882OtherUNITED HEALTHCARE
NED03616OtherBCBS OF NEBRASKA
NE1700882OtherUNITED HEALTHCARE