Provider Demographics
NPI:1871055202
Name:KITSIS, MICHELLE REBECCA (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:REBECCA
Last Name:KITSIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11893 STONEY BAY CIR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9501
Mailing Address - Country:US
Mailing Address - Phone:317-383-6284
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL SQ STE 100
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2819
Practice Address - Country:US
Practice Address - Phone:317-462-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01093074A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery