Healthcare Provider Details

I. General information

NPI: 1114919958
Provider Name (Legal Business Name): ANN MARIE WITT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 SOUTH GREEN ROAD
SOUTH EUCLID OH
44121
US

IV. Provider business mailing address

2054 SOUTH GREEN ROAD
SOUTH EUCLID OH
44121
US

V. Phone/Fax

Practice location:
  • Phone: 216-291-9210
  • Fax: 216-291-9422
Mailing address:
  • Phone: 216-291-9210
  • Fax: 216-291-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35075581
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: