Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301085515 | MI |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 4301085515 | MI |
NPI | 1063615854 |
---|---|
Provider Name | Dr. Joshua Peter Ellwitz |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063615854 | (05) | MI |
2003907192 | BCBS (01) | MI |