Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 64170 | MN |
N | 207R00000X | Internist | 28330 | MN |
N | 111NI0900X | Internist | 28330 | MN |
N | 207R00000X | Internist | 64170 | MN |
N | 111NI0900X | Internist | 64170 | MN |
NPI | 1073044574 |
---|---|
Provider Name | Mitchell Pitlick |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2017 |
Last Update Date | 06/08/2020 |