Provider Demographics
NPI:1164486338
Name:WITTENBERG, AARON (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:WITTENBERG
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 1:4201 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8409
Mailing Address - Country:US
Mailing Address - Phone:815-334-5566
Mailing Address - Fax:815-759-4008
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-334-5566
Practice Address - Fax:815-759-4008
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ349612085R0202X, 2085R0204X
IL0361576922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004736Medicaid
AZAZ0221810OtherBCBSAZ
AZ1Z7086OtherHEALTH NET OF AZ
AZZ109492Medicare PIN
AZZ121394Medicare PIN
AZP00335833Medicare PIN
AZAZ0221810OtherBCBSAZ
AZZ109491Medicare PIN
AZ1Z7086OtherHEALTH NET OF AZ
I34302Medicare UPIN
AZZ109490Medicare PIN