Provider Demographics
NPI:1043427743
Name:WILTZ MEDICAL GROUP INC
Entity Type:Organization
Organization Name:WILTZ MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTHON
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-554-8888
Mailing Address - Street 1:1401 SW 107TH AVE
Mailing Address - Street 2:SUITE 301J
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2524
Mailing Address - Country:US
Mailing Address - Phone:305-223-9800
Mailing Address - Fax:305-223-9810
Practice Address - Street 1:1401 SW 107TH AVE
Practice Address - Street 2:SUITE 301J
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2524
Practice Address - Country:US
Practice Address - Phone:305-223-9800
Practice Address - Fax:305-223-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty