Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | P57178 | NY |
N | 208200000X | Surgeon | P57178 | NY |
N | 208600000X | Surgeon | P57178 | NY |
N | 2086S0129X | Vascular Surgeon | P57178 | NY |
NPI | 1104058023 |
---|---|
Provider Name | Dr. Piotr Pawel Witkowski |
First Address | Chicago, IL 60637-1447 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 11/08/2009 |