Provider Demographics
NPI:1891780888
Name:NITSCH, STEVEN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:NITSCH
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 1:575 W CROSSTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1908
Mailing Address - Country:US
Mailing Address - Phone:269-343-5750
Mailing Address - Fax:269-343-4936
Practice Address - Street 1:575 W CROSSTOWN PKWY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1908
Practice Address - Country:US
Practice Address - Phone:269-343-5750
Practice Address - Fax:269-343-4936
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039963208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13-30483OtherPHYSICIANS HEALTH PLAN
MI0390985OtherBLUESHIELD OF MICHIGAN
MI4167184Medicaid
MI4319126OtherAETNA
MI13-30483OtherPHYSICIANS HEALTH PLAN
MI4319126OtherAETNA