Provider Demographics
NPI:1750630117
Name:FITCH, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FITCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGHWAY 361
Mailing Address - Street 2:BLDG 2516 / MEDICAL
Mailing Address - City:CRANE
Mailing Address - State:IN
Mailing Address - Zip Code:47522-4000
Mailing Address - Country:US
Mailing Address - Phone:812-854-1220
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHWAY 361
Practice Address - Street 2:BLDG 2516 / MEDICAL
Practice Address - City:CRANE
Practice Address - State:IN
Practice Address - Zip Code:47522-4000
Practice Address - Country:US
Practice Address - Phone:812-854-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203591208D00000X
390200000X
MT779262083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program