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NPI Code Detail

MEDICARE: DIANE M WITEK M.D.

MEDICARE: DIANE M WITEK M.D.
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
1207Q00000XFamily Medicine Physician52622WI

General Provider Information

NPI Number : 1316157779
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE M WITEK M.D.
Provider Business Mailing Address
First Line : 1700 W PARADISE DR
Second Line :
City : WEST BEND
State : WI
Zip : 53095-9795
Country : US
Telephone Number : 262-334-3451
Fax Number : 262-306-2964
Provider Business Practice Location Address
First Line : W225N16711 CEDAR PARK CT
Second Line :
City : JACKSON
State : WI
Zip : 53037-9222
Country : US
Telephone Number : 262-677-1101
Fax Number : 262-306-2964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 04/01/2013

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