MEDICARE: ELISSA WHITTENBURG MD

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	207R00000X	Internal Medicine Physician	35075467	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770526204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA WHITTENBURG MD

Provider Business Mailing Address
First Line	:	3200 BURNET AVE
Second Line	:	3 SOUTH CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3019
Country	:	US
Telephone Number	:	513-298-7325
Fax Number	:	513-298-7406

Provider Business Practice Location Address
First Line	:	7700 UNIVERSITY DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2505
Country	:	US
Telephone Number	:	513-298-7325
Fax Number	:	513-298-7406

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/26/2014

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Directions to “ ELISSA WHITTENBURG MD” Practice Location

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