| Doctor Name: | MICHAEL J MIKITISH |
| NPI Number: | 1134415870 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PS004701L |
| Business Practice Address: | 60 Township Line Rd Elkins Park, PA - 190272220 |
| Business Phone Number: | 2158312400 |
| Business Fax Number: | |
| Mailing Address: | 101 E Olney Ave, Suite 400 PHILADELPHIA |
| State: | PA |
| Postal Code: | 191202421 |
| Phone Number: | 2152542630 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2011 |
| NPI Last Update Date: | 06/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PS004701L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |