Individual
WISAM A. WITWIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
60 MEMORIAL MEDICAL PKWY, PALM COAST, FL 32164-5980
(386) 586-2000
(317) 705-5047
Mailing address
60 MEMORIAL MEDICAL PKWY, PALM COAST, FL 32164-5980
(386) 586-2000
(317) 705-5047
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301110641
MI
2085N0700X
Neuroradiology Physician
Primary
ME155790
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/04/2016
Last updated
05/09/2023
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