Provider Demographics
NPI:1558590380
Name:WILLIAM O. WITT, M.D., PLLC
Entity Type:Organization
Organization Name:WILLIAM O. WITT, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ORIN
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-367-7246
Mailing Address - Street 1:3649 SOLUTIONS CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3006
Mailing Address - Country:US
Mailing Address - Phone:859-367-7246
Mailing Address - Fax:859-254-5715
Practice Address - Street 1:2050 VERSAILLES RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1405
Practice Address - Country:US
Practice Address - Phone:859-367-7246
Practice Address - Fax:859-254-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19042208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid
KYPTAN 01096Medicare PIN