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DAVID FREDERICK WIDITZ MD NPI 1205015906


NPI Information

NPI: 1205015906
Provider Name: DAVID FREDERICK WIDITZ, MD
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

PECOS Registration: Yes

Address:
421 W BROADWAY STE 302
COUNCIL BLUFFS, IA
ZIP 51503
Phone: (319) 208-2744
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David Frederick Widitz, MD is a child and adolescent psychiatry psychiatry neurology in Council Bluffs, IA with 19 years of experience. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. David Frederick Widitz, MD NPI is 1205015906. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: PENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
Graduation Year:2005

The provider's business location address is:

421 W BROADWAY STE 302
COUNCIL BLUFFS, IA
ZIP 51503-046
Phone: (319) 208-2744
Fax: (319) 208-2627

The NPI 1205015906 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/30/2007 and was last updated on 2/1/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12084P0800XPsychiatry & NeurologyPsychiatry036166942ILLINOISNo
22084P0800XPsychiatry & NeurologyPsychiatry37338IOWANo
32084P0804XPsychiatry & NeurologyChild & Adolescent Psychiatry37338IOWANo
42084P0804XPsychiatry & NeurologyChild & Adolescent Psychiatry036166942ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.