Provider Demographics
NPI:1689663437
Name:PITT, ELIZABETH S (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:PITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W WESTERN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1045
Mailing Address - Country:US
Mailing Address - Phone:231-726-4498
Mailing Address - Fax:231-726-4468
Practice Address - Street 1:1700 CLINTON ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5502
Practice Address - Country:US
Practice Address - Phone:231-726-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEP052187207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1878034OtherMEDICARE ID - TYPE UNSPECIFIED
MI1578703252Medicaid
I15805Medicare UPIN