Individual
DR. JEREMY SCOTT WITTENBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5510 S EAST ST STE H, INDIANAPOLIS, IN 46227-1939
(317) 924-8425
(317) 924-8424
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 573-5000
(630) 491-5472
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01062568A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000612520
ANTHEM PIN
IN
05
—
200836520
—
IN
Enumeration date
08/05/2006
Last updated
12/01/2022
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