Healthcare Provider Details

I. General information

NPI: 1760623110
Provider Name (Legal Business Name): AMY WOIKE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY WOYTOWICH D.O.

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 75TH ST
KENOSHA WI
53142-7884
US

IV. Provider business mailing address

10400 75TH ST
KENOSHA WI
53142-7884
US

V. Phone/Fax

Practice location:
  • Phone: 262-948-7370
  • Fax:
Mailing address:
  • Phone: 262-948-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036128618
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5755221
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: