MEDICARE: DR. DOYLE THOMAS WITT M.D.

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	207Q00000X	Family Medicine Physician	036141161	IL

General Provider Information

NPI Number	:	1649613134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOYLE THOMAS WITT M.D.

Provider Business Mailing Address
First Line	:	16 KNOLLWOOD DR
Second Line	:
City	:	CHESTER
State	:	IL
Zip	:	62233-1415
Country	:	US
Telephone Number	:	417-880-2545
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 OLD PLANK RD
Second Line	:
City	:	CHESTER
State	:	IL
Zip	:	62233-1153
Country	:	US
Telephone Number	:	618-826-2388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	08/08/2016

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