Individual
JASON M NITKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1881 CHICAGO ST, DE PERE, WI 54115-3770
(920) 403-8000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
46872
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43515200
—
WI
Enumeration date
05/05/2006
Last updated
06/11/2024
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