Basic Information
| Provider Information | |||||||||
| NPI: | 1730171083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BITTENBENDER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471504649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129452100 | ||||||||
| FaxNumber: | 9459459495 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471504649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129452100 | ||||||||
| FaxNumber: | 9459459495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01051406A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200242050 | 05 | IN | MEDICAID | 0101202 | 01 | IN | UNITED HEALTHCARE PROV # | OTHER | 64114937 | 05 | KY | MEDICAID | 080176753 | 01 | IN | RAILROAD MEDICARE PROV # | OTHER | 000000206457 | 01 | IN | ANTHEM PROV # | OTHER | 352154103B | 01 | KY | HUMANA PROV # | OTHER |