Provider Demographics
NPI:1851715536
Name:WITT, GLORIA M KLAASSEN (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:M KLAASSEN
Last Name:WITT
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:493 N DERENZY RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49622-9566
Mailing Address - Country:US
Mailing Address - Phone:231-544-7001
Mailing Address - Fax:231-600-7054
Practice Address - Street 1:493 N DERENZY RD
Practice Address - Street 2:
Practice Address - City:CENTRAL LAKE
Practice Address - State:MI
Practice Address - Zip Code:49622-9566
Practice Address - Country:US
Practice Address - Phone:231-544-7001
Practice Address - Fax:231-600-7054
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine