Individual
DR. MARK WITECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8600 SHERIDAN RD STE 600, KENOSHA DIV OF HEALTH LAB, KENOSHA, WI 53143-6515
(262) 605-6700
(262) 605-6715
Mailing address
8600 SHERIDAN RD STE 600, KENOSHA DIV OF HEALTH LAB, KENOSHA, WI 53143-6515
(262) 605-6700
(262) 605-6715
Taxonomy
Speciality
Code
Description
License number
State
246QL0900X
Laboratory Management Specialist/Technologist
Primary
28122-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32924500
—
WI
Enumeration date
09/15/2008
Last updated
09/15/2008
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