Doctor Name: | ANTHONY J. WITT |
NPI Number: | 1083063762 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 611 E Douglas Rd Suite 407 Mishawaka, IN - 465451464 |
Business Phone Number: | 5743356500 |
Business Fax Number: | 5743350771 |
Mailing Address: | Po Box 6309, Saint Joseph Physician Network-cbo SOUTH BEND |
State: | IN |
Postal Code: | 466606309 |
Phone Number: | 5743358700 |
Fax Number: | 5743350741 |
NPI Enumeration Date: | 06/03/2016 |
NPI Last Update Date: | 06/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |