Provider Demographics
NPI:1063615854
Name:ELLWITZ, JOSHUA PETER (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:PETER
Last Name:ELLWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M206A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-488-8355
Mailing Address - Fax:269-488-8356
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:M206A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-488-8355
Practice Address - Fax:269-488-8356
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085515207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2003907192OtherBCBS
MI1063615854Medicaid
MI1063615854Medicaid