Individual
MICHELLE WITKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-6520
(231) 935-9116
Mailing address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-6520
(231) 935-9116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704118876
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104307463
—
MI
05
—
104518216
—
MI
01
—
500B814150
BLUE CROSS GROUP PRACTICE PIN
MI
01
—
MW118876
BLUE CROSS
MI
Enumeration date
10/25/2006
Last updated
05/26/2009
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