Healthcare Provider Details

I. General information

NPI: 1922493477
Provider Name (Legal Business Name): MICHAEL WITTEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST
FORT PIERCE FL
34950
US

IV. Provider business mailing address

270 CRESTWOOD CIR APT 203
ROYAL PALM BEACH FL
33411-4966
US

V. Phone/Fax

Practice location:
  • Phone: 305-796-3284
  • Fax:
Mailing address:
  • Phone: 305-796-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number134302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: