MEDICARE: DR. NEAL P WITTELS 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	261QA1903X	Ambulatory Surgical Clinic/Center	ME0037061	FL

General Provider Information

NPI Number	:	1740306554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEAL P WITTELS M.D.

Provider Business Mailing Address
First Line	:	16400 NW 2ND AVE
Second Line	:	102
City	:	MIAMI
State	:	FL
Zip	:	33169-6035
Country	:	US
Telephone Number	:	305-940-6750
Fax Number	:	305-940-9222

Provider Business Practice Location Address
First Line	:	16400 NW 2ND AVE
Second Line	:	102
City	:	MIAMI
State	:	FL
Zip	:	33169-6035
Country	:	US
Telephone Number	:	305-940-6750
Fax Number	:	305-940-9222

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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