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General NPI Number Information
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NPI Number | 1770526204
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Entity Type | Individual
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Provider Name | ELISSA WHITTENBURG MD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 2460 GREENTREE RD STE D
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City | LEBANON
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State | OH
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Zip | 45036-9604
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Country | US
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Telephone | 314-888-5233
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Fax | 513-880-0676
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Provider Business Mailing Address
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Address Line | 726 E MAIN ST STE F
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City | LEBANON
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State | OH
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Zip | 45036-1900
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Country | US
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Telephone | 314-888-5233
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Fax | 513-880-0676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35075467
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License Number State | OH
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