Provider Demographics
NPI:1619998853
Name:WITTELS ORTHOPAEDIC & SPORTS MEDICINE CENTER PA
Entity Type:Organization
Organization Name:WITTELS ORTHOPAEDIC & SPORTS MEDICINE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WITTELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-866-4664
Mailing Address - Street 1:1085 KANE CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2105
Mailing Address - Country:US
Mailing Address - Phone:305-866-4664
Mailing Address - Fax:305-861-5558
Practice Address - Street 1:1085 KANE CONCOURSE
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2105
Practice Address - Country:US
Practice Address - Phone:305-866-4664
Practice Address - Fax:305-861-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34347OtherBCBS
FL0498480001Medicare NSC
FLK1467Medicare PIN