Provider Demographics
NPI:1619184272
Name:STEVEN N WITLIN MD INC
Entity Type:Organization
Organization Name:STEVEN N WITLIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WITLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-845-9311
Mailing Address - Street 1:285 S SPALDING DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3651
Mailing Address - Country:US
Mailing Address - Phone:310-845-9311
Mailing Address - Fax:310-845-9523
Practice Address - Street 1:285 S SPALDING DR UNIT 3
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3651
Practice Address - Country:US
Practice Address - Phone:310-845-9311
Practice Address - Fax:310-845-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC18702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C187020Medicaid
CAA31317Medicare UPIN
CAC18702Medicare ID - Type UnspecifiedMEDICARE PROV ID