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NPI Code Detail

MEDICARE: MICHAEL WITTEK RPA

MEDICARE: MICHAEL WITTEK RPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant006198NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P019006198OTHERNYBLUE CHOICE PROVIDER

General Provider Information

NPI Number : 1043301161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WITTEK RPA
Provider Business Mailing Address
First Line : 326 N MAIN ST
Second Line :
City : CANANDAIGUA
State : NY
Zip : 14424-1222
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6254 LAWVILLE RD
Second Line :
City : WOLCOTT
State : NY
Zip : 14590-9792
Country : US
Telephone Number : 315-594-9444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 04/28/2021

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Directions to “ MICHAEL WITTEK RPA” Practice Location

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