Individual
KEVIN LEE WITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10101 ERNST RD STE 1200, ROANOKE, IN 46783-9711
(260) 234-5400
(260) 235-5410
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01074572A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001030505
ANTHEM PTAN
IN
01
—
000001525811
ANTHEM PTAN
IN
01
—
1102404078
ANTHEM PTAN
IN
01
—
1922441757
ANTHEM PTAN
IN
05
—
201185280
—
IN
01
—
P01801391
RR MEDICARE
IN
Enumeration date
04/11/2013
Last updated
01/09/2025
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