Provider Demographics
NPI:1902256050
Name:MCVITTIE, MALORIE (MD)
Entity Type:Individual
Prefix:
First Name:MALORIE
Middle Name:
Last Name:MCVITTIE
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427-0126
Mailing Address - Country:US
Mailing Address - Phone:810-376-2835
Mailing Address - Fax:810-376-9412
Practice Address - Street 1:2433 BLACK RIVER ST
Practice Address - Street 2:
Practice Address - City:DECKERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48427-9425
Practice Address - Country:US
Practice Address - Phone:810-376-2885
Practice Address - Fax:810-376-8301
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110248208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics