Provider Demographics
NPI:1811020829
Name:LITWICKI, MICHAEL LEE (MIKE LITWICKI PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:LITWICKI
Suffix:
Gender:M
Credentials:MIKE LITWICKI PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 VERNA ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3550
Mailing Address - Country:US
Mailing Address - Phone:409-381-8141
Mailing Address - Fax:
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 601 A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:800-258-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS64471Medicare UPIN
TX82N060Medicare ID - Type Unspecified