Provider Demographics
NPI:1740306554
Name:WITTELS, NEAL P (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:P
Last Name:WITTELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 NW 2ND AVE
Mailing Address - Street 2:102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6035
Mailing Address - Country:US
Mailing Address - Phone:305-940-6750
Mailing Address - Fax:305-940-9222
Practice Address - Street 1:16400 NW 2ND AVE
Practice Address - Street 2:102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6035
Practice Address - Country:US
Practice Address - Phone:305-940-6750
Practice Address - Fax:305-940-9222
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037061261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB14938Medicare UPIN