Healthcare Provider Details

I. General information

NPI: 1619927662
Provider Name (Legal Business Name): LISA CATHERINE WITTMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 ENTERPRISE CIR STE 130
LAKEWOOD RANCH FL
34202-4111
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-3000
  • Fax: 941-917-3002
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: