Provider Demographics
NPI:1154373199
Name:WITT, MICHAEL ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:WITT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 MERCHANT STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-6507
Mailing Address - Fax:513-645-9767
Practice Address - Street 1:1425 N FAIRFIELD RD.
Practice Address - Street 2:STE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-4543
Practice Address - Country:US
Practice Address - Phone:937-426-0106
Practice Address - Fax:937-426-7153
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-01-25
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Provider Licenses
StateLicense IDTaxonomies
GA26045207Q00000X
OH35122511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00283621AMedicaid
OH0120611Medicaid
OHH273720Medicare PIN
GA00283621AMedicaid