Provider Demographics
NPI:1861568479
Name:HEWITT, MITZIE JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:MITZIE
Middle Name:JEAN
Last Name:HEWITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11293 N M-37
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUCKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49620
Mailing Address - Country:US
Mailing Address - Phone:231-269-4185
Mailing Address - Fax:231-269-4461
Practice Address - Street 1:11293 N M-37
Practice Address - Street 2:SUITE A
Practice Address - City:BUCKLEY
Practice Address - State:MI
Practice Address - Zip Code:49620
Practice Address - Country:US
Practice Address - Phone:231-269-4185
Practice Address - Fax:231-269-4461
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4513149Medicaid
MI4513149Medicaid
MIG94472Medicare UPIN