Provider Demographics
NPI:1902086838
Name:K E PITTS MD PC
Entity type:Organization
Organization Name:K E PITTS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:810-229-0350
Mailing Address - Street 1:4522 OAK POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9184
Mailing Address - Country:US
Mailing Address - Phone:810-229-0350
Mailing Address - Fax:
Practice Address - Street 1:4522 OAK POINTE DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9184
Practice Address - Country:US
Practice Address - Phone:810-229-0350
Practice Address - Fax:810-844-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKP02003612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKP020031OtherSTATE LICENCES
MIKP020031OtherSTATE LICENCES