Basic Information
| Provider Information | |||||||||
| NPI: | 1558339333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WITTY | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 S TURNBERRY LN | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473969232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652812000 | ||||||||
| FaxNumber: | 7652812062 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 W UNIVERSITY AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473033421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652812000 | ||||||||
| FaxNumber: | 7652812062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 01036903A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 100379100A | 05 | IN | MEDICAID |