Provider Demographics
NPI:1821090275
Name:HITTLE, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HITTLE
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-0129
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:1 MEMORIAL SQ STE 305
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3308
Practice Address - Country:US
Practice Address - Phone:317-462-6662
Practice Address - Fax:317-468-6275
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041331A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110215614OtherMEDICARE RAILROAD #
IN200026730Medicaid
IN200311740HOtherMEDICAID GROUP #
IN000000112531OtherANTHEM PIN #
IN4398281OtherAETNA PIN #
IN200311740HOtherMEDICAID GROUP #
205110PMedicare Oscar/Certification