Individual
DR. GARY WITUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 983-8601
Mailing address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
03087
KY
207Q00000X
Family Medicine Physician
57339
WI
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
5101011763
MI
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
57339
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000601505
ANTHEM
KY
05
—
3300156
—
TN
05
—
7100075950
—
KY
Enumeration date
02/21/2006
Last updated
10/30/2024
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