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Individual

WILLIAM L. WITTMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4530
(859) 258-4870
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4530
(859) 258-4870

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22970
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
36000818
MEDICAID ASC GRP
KY
01
37903705
MEDICAID LAB GRP
KY
01
4000501
MEDICARE LAB GRP
KY
05
64229701
KY
01
ASC1019
MEDICARE ASC GRP
KY
01
CB5773
RR MEDICARE GRP
GA
Enumeration date
07/26/2006
Last updated
11/02/2007
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