Provider Demographics
NPI:1770691073
Name:BELITZ, MICHAEL (PA C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BELITZ
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7092 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1502
Mailing Address - Country:US
Mailing Address - Phone:248-366-3266
Mailing Address - Fax:248-366-3305
Practice Address - Street 1:7092 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1502
Practice Address - Country:US
Practice Address - Phone:248-366-3266
Practice Address - Fax:248-366-3305
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ02063Medicare UPIN