NPIMap

Individual provider Active NPI

John W Kitzmiller, MD

  • Addiction Medicine (Family Medicine) Physician
  • Lake Orion, MI
National Provider Identifier
1811988504
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
4301036695 Issued in MI
Practice address
1455 S Lapeer Rd Ste 200
Lake Orion, MI 48360-1468
Phone
(248) 693-4000
Fax
(248) 690-9361
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301006731 MI
Addiction Medicine (Family Medicine) Physician 207QA0401X 4301036695 MI Primary

Addresses

Primary practice location

1455 S Lapeer Rd Ste 200
Lake Orion, MI 48360-1468

Mailing address

1455 S Lapeer Rd Ste 200
Lake Orion, MI 48360-1468
Phone (248) 693-4000

Other identifiers 3

IdentifierTypeStateIssuer
1518393800MedicaidMI
1811988504MedicaidMI
0606301871OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130930000561 MI Practitioner - General PracticePractitioner - Addiction MedicinePractitioner - Vascular SurgeryPractitioner - Pain ManagementPractitioner - Peripheral Vascular DiseasePractitioner - Podiatry 9638303910 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Addiction Medicine, Peripheral Vascular Disease, Podiatry, Vascular Surgery
Education
Wayne State University School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John Kitzmiller M.D. PCGroup PAC ID 7911131297, 4 clinicians

Practice addresses (Care Compare)

1455 S Lapeer Rd
Suite 200
Lake Orion, MI 48360-1468
Phone (248) 693-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6301006731MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
John Kitzmiller M.D. PC Addiction Medicine CurrentSince Jun 5, 2013 Accepting new patients
MVP Diagnostic Laboratory LLC PastSince Sep 1, 2020 Accepting new patients
Quest Diagnostics Incorporated Mi Past Accepting new patients

Locations

1375 S Lapeer Rd
Ste 203
Lake Orion, MI 48360
Phone (248) 693-0893

1455 S Lapeer Rd
Ste 200
Lake Orion, MI 48360
Phone (248) 693-1986

801 Joe Mann Blvd
Ste P-6
Midland, MI 48642

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1811988504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 S LAPEER RD STE 200",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601468",
            "telephone_number": "248-693-4000",
            "fax_number": "248-690-9361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 S LAPEER RD STE 200",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601468",
            "telephone_number": "248-693-4000",
            "fax_number": "248-690-9361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITZMILLER",
        "first_name": "JOHN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301006731",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MI",
            "license": "4301036695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1518393800",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811988504",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0606301871",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Orion, MI

Sources for this page

Verify at the official NPI Registry.