Individual
LILY J WITTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
104 W 5TH AVE, SUITE 200W, SPOKANE, WA 99204-4880
(509) 624-2313
(509) 459-0686
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-8526
(509) 459-0686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60404330
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/24/2011
Last updated
02/08/2016
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