Provider Demographics
NPI:1235818485
Name:WITTKORN, GREGORY JOSEPH
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:WITTKORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 S SECTION LINE RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-9253
Mailing Address - Country:US
Mailing Address - Phone:740-417-0670
Mailing Address - Fax:
Practice Address - Street 1:5840 S SECTION LINE RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-9253
Practice Address - Country:US
Practice Address - Phone:740-417-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker