Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 69577 | WI |
NPI | 1013270644 |
---|---|
Provider Name | Brent Witten |
First Address | Milwaukee, WI 53215-3678 |
Second Address | Milwaukee, WI 53215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 24/11/2021 |