Provider Demographics
NPI:1366550402
Name:GITELIS, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GITELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 SMOKE RANCH RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3157
Mailing Address - Country:US
Mailing Address - Phone:702-320-8111
Mailing Address - Fax:702-320-8112
Practice Address - Street 1:7140 SMOKE RANCH RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:702-320-8111
Practice Address - Fax:702-320-8112
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055465207X00000X, 207XX0005X
NV22971207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
207906OtherMEDICARE GRP-MCHENRY CTY
200017454OtherRR MEDICARE PROV
CE6001OtherRR MEDICARE GRP-KANE
IL036055465Medicaid
208821OtherMEDICARE GRP KANE
CG2631OtherRR MEDICARE MCHENRY CTY
CG2631OtherRR MEDICARE MCHENRY CTY
IL0354460003Medicare NSC
207906OtherMEDICARE GRP-MCHENRY CTY
208821OtherMEDICARE GRP KANE
IL0354460001Medicare NSC
IL0354460005Medicare NSC