Healthcare Provider Details

I. General information

NPI: 1558590380
Provider Name (Legal Business Name): WILLIAM O. WITT, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES RD SUITE 205
LEXINGTON KY
40504-1405
US

IV. Provider business mailing address

3649 SOLUTIONS CENTER
CHICAGO IL
60677-3006
US

V. Phone/Fax

Practice location:
  • Phone: 859-367-7246
  • Fax: 859-254-5715
Mailing address:
  • Phone: 859-367-7246
  • Fax: 859-254-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number19042
License Number StateKY

VIII. Authorized Official

Name: WILLIAM ORIN WITT
Title or Position: OWNER/REGISTERED AGENT
Credential: M.D.
Phone: 859-367-7246