Healthcare Provider Details

I. General information

NPI: 1982998100
Provider Name (Legal Business Name): MARK LESLIE WITKOWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 HIGHWAY 17 SUITE 202
MURRELLS INLET SC
29576-5098
US

IV. Provider business mailing address

PO BOX 421718
GEORGETOWN SC
29442-4203
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-8390
  • Fax: 843-652-8391
Mailing address:
  • Phone: 843-527-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR9182
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: