MEDICARE: LEE A WITTENBERG DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	2301	MA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2949	FL
3	213ES0103X	Foot & Ankle Surgery Podiatrist	0607	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	Y78152	OTHER		MEDICARE B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	042472266	OTHER	ONE HEALTH PLAN
2	7126566	OTHER	AETNA US HEALTHCARE
4	8466748	OTHER	CIGNA HEALTH PLAN
5	042472266	OTHER	PRIVATE HEALTHCARE SYSTEM
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	5617306	OTHER	FIRST HEALTH
8	042472266	OTHER	TRICARE CHAMPUS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700868643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE A WITTENBERG DPM

Provider Business Mailing Address
First Line	:	2901 N TENAYA WAY STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1404
Country	:	US
Telephone Number	:	702-362-2622
Fax Number	:	702-362-0422

Provider Business Practice Location Address
First Line	:	2901 N TENAYA WAY STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1404
Country	:	US
Telephone Number	:	702-362-2622
Fax Number	:	702-362-0422

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	05/13/2023

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Directions to “ LEE A WITTENBERG DPM” Practice Location

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