Healthcare Provider Details

I. General information

NPI: 1316262710
Provider Name (Legal Business Name): SAMUEL GEORGE WITTEKIND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. ML 2003
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE. ML 2003
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4432
  • Fax: 513-636-3952
Mailing address:
  • Phone: 513-636-4432
  • Fax: 513-636-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number271030-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35.134313
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.025498
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMED-PHYS-LIC-113820
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60156855
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: