MEDICARE: VENUS WITTENAUER, D.O., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	34006914M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124312392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENUS WITTENAUER, D.O., INC

Provider Business Mailing Address
First Line	:	PO BOX 489
Second Line	:
City	:	EAST PALESTINE
State	:	OH
Zip	:	44413-0489
Country	:	US
Telephone Number	:	330-426-3578
Fax Number	:	330-426-2458

Provider Business Practice Location Address
First Line	:	1517 N MARKET ST
Second Line	:
City	:	EAST PALESTINE
State	:	OH
Zip	:	44413-1153
Country	:	US
Telephone Number	:	330-426-3578
Fax Number	:	330-426-2458

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VENUS WITTENAUER
Credential	:	D.O.
Telephone Number	:	330-426-3578

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	06/06/2011

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