Provider Demographics
NPI:1851305221
Name:TRITTSCHUH, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:TRITTSCHUH
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 1:4016 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006
Mailing Address - Country:US
Mailing Address - Phone:269-344-3366
Mailing Address - Fax:269-344-3676
Practice Address - Street 1:4016 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006
Practice Address - Country:US
Practice Address - Phone:269-344-3366
Practice Address - Fax:269-344-3676
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJT031851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180399449OtherBLUE CROSS BLUE SHIELD
MI0524240001OtherADMINISTAR FEDERAL
MI180012001OtherPALAMETTO GBA
MI0830973OtherIBA PHP
MI102966940Medicaid
MI0830973OtherIBA PHP
MI102966940Medicaid