Provider Demographics
NPI:1073044574
Name:PITLICK, MITCHELL M (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:M
Last Name:PITLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2808 SOUTH 80TH AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3253
Mailing Address - Country:US
Mailing Address - Phone:402-391-1800
Mailing Address - Fax:402-391-1563
Practice Address - Street 1:2808 SOUTH 80TH AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3253
Practice Address - Country:US
Practice Address - Phone:402-391-1800
Practice Address - Fax:402-391-1563
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN64170207R00000X
NE35674207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine