Provider Demographics
NPI:1255355087
Name:FITE, MICHAEL Q (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:Q
Last Name:FITE
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 1:6420 SW MACADAM AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 14TH ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4688
Practice Address - Country:US
Practice Address - Phone:404-814-0923
Practice Address - Fax:415-680-1525
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD170487207Q00000X, 207Q00000X
GA50368207Q00000X
TXN7258207Q00000X
NC2012-01898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500692319Medicaid
WI34063200Medicaid
NCNCA354BMedicare PIN
NCNCA354AMedicare PIN
SCNC1744Medicaid
H32480Medicare UPIN
NC5922172Medicaid