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General NPI Number Information
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NPI Number | 1811657687
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Entity Type | Organization
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Legal Business Name | JONATHANDWITZKEMD, PLLC
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 7450 FRANCE AVE S STE 220
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City | EDINA
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State | MN
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Zip | 55435-4792
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Country | US
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Telephone | 952-925-1111
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Fax | 952-922-3446
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE MS: 21110Q
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone | 651-254-8290
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Fax | 651-254-8299
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN DAVID WITZKE
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Credential | MD
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Telephone | 952-925-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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