MEDICARE: STEVEN PHILIP WITTMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-065551	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00391427	OTHER	NC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	9401098	OTHER	NC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1104820869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN PHILIP WITTMER MD

Provider Business Mailing Address
First Line	:	150 S INGLESIDE ST STE 6
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-1804
Country	:	US
Telephone Number	:	251-990-1740
Fax Number	:	251-990-1831

Provider Business Practice Location Address
First Line	:	150 S INGLESIDE ST STE 6
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-1804
Country	:	US
Telephone Number	:	251-990-1740
Fax Number	:	251-990-1831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	06/09/2020

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Directions to “ STEVEN PHILIP WITTMER MD” Practice Location

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