Healthcare Provider Details

I. General information

NPI: 1649974585
Provider Name (Legal Business Name): MACKENZIE CARUTHERS WITTIG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE CARUTHERS DO

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 OLENTANGY RIVER RD
COLUMBUS OH
43214-3440
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5456
  • Fax: 614-566-6902
Mailing address:
  • Phone: 614-566-5456
  • Fax: 614-566-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018626
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.018626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: