Individual
MICHAEL WITTEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA
Contact information
Practice address
6254 LAWVILLE RD, WOLCOTT, NY 14590-9792
(315) 594-9444
Mailing address
326 N MAIN ST, CANANDAIGUA, NY 14424-1222
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006198
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P019006198
BLUE CHOICE PROVIDER
NY
Enumeration date
09/27/2006
Last updated
04/28/2021
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