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Individual

MICHAEL J MIKITISH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
60 TOWNSHIP LINE RD, ELKINS PARK, PA 19027-2220
(215) 831-2400
Mailing address
101 E OLNEY AVE, SUITE 400, PHILADELPHIA, PA 19120-2421
(215) 254-2630

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS004701L
PA

Other

Enumeration date
06/21/2011
Last updated
06/21/2011
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