Provider Demographics
NPI:1699937896
Name:MITITELU, MIHAI (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MIHAI
Middle Name:
Last Name:MITITELU
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3611
Mailing Address - Country:US
Mailing Address - Phone:312-695-6514
Mailing Address - Fax:
Practice Address - Street 1:2880 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3644
Practice Address - Country:US
Practice Address - Phone:608-263-7171
Practice Address - Fax:608-265-8060
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61259207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130598Medicaid
IL036130598Medicaid