Brian C. Wittmayer, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016-005326 Issued in IL

Practice address

401 E. 162ND St
Suite 101
South Holland, IL 60473-2236

Phone

(708) 596-3757

Fax

(708) 596-3779

NPI assigned

Jan 6, 2007

Last updated

Jun 20, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213920000000",
    "number": "1174671333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E. 162ND STREET",
            "address_2": "SUITE 101",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "60473",
            "telephone_number": "708-596-3757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E. 162ND ST",
            "address_2": "SUITE 101",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732236",
            "telephone_number": "708-596-3757",
            "fax_number": "708-596-3779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTMAYER",
        "first_name": "BRIAN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-06",
        "last_updated": "2008-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016-005326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in South Holland, IL
• Providers in South Holland, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.