Provider Demographics
NPI:1013991678
Name:WITTA, SAMIR EZZELDIN (MD PHD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:EZZELDIN
Last Name:WITTA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4747 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-5917
Mailing Address - Country:US
Mailing Address - Phone:303-870-3293
Mailing Address - Fax:303-586-2228
Practice Address - Street 1:3501 S CORONA ST STE 1
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3907
Practice Address - Country:US
Practice Address - Phone:303-999-6745
Practice Address - Fax:303-586-2228
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039762207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82076529Medicaid
CO82076529Medicaid
COCO41218Medicare PIN