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General NPI Number Information
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NPI Number | 1154651727
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Entity Type | Individual
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Provider Name | MATTHEW EDWARD WITEK MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 309 W JOHNSON ST APT 714
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City | MADISON
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State | WI
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Zip | 53703-3553
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Country | US
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Telephone | 215-806-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 309 W JOHNSON ST APT 714
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City | MADISON
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State | WI
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Zip | 53703-3553
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Country | US
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Telephone | 215-806-4460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 62371
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License Number State | WI
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