Provider Demographics
NPI:1275653941
Name:WITTELS, ELLISON HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLISON
Middle Name:HAROLD
Last Name:WITTELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6360 W SAM HOUSTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5164
Mailing Address - Country:US
Mailing Address - Phone:713-280-0363
Mailing Address - Fax:713-280-0364
Practice Address - Street 1:2929 BUFFALO SPEEDWAY
Practice Address - Street 2:# 1701
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1720
Practice Address - Country:US
Practice Address - Phone:281-216-4319
Practice Address - Fax:713-622-7466
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y409Medicare PIN
TX8L22117Medicare UPIN