Individual
SUSAN MICHELLE WITTLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14 VILLAGE SQUARE SHOP CTR, HAZELWOOD, MO 63042-1818
(636) 253-0493
Mailing address
2436 MIRASOL TRL, EUREKA, MO 63025, EUREKA, MO 63025
(636) 253-0493
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
111398
MO
Other
Enumeration date
06/08/2011
Last updated
05/13/2026
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