Provider Demographics
NPI:1992852834
Name:FITCH, MICHAEL K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:FITCH
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 1:141 MORNINGWINGS LANE
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-7354
Mailing Address - Country:US
Mailing Address - Phone:360-837-3163
Mailing Address - Fax:
Practice Address - Street 1:406 SE 131ST AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4031
Practice Address - Country:US
Practice Address - Phone:360-253-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000040363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7023179Medicaid
WA7023179Medicaid