Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036123834 | IL |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 036-123834 | IL |
NPI | 1750598850 |
---|---|
Provider Name | Gregory P Witkowski |
First Address | Warrenville, IL 60555-3845 |
Second Address | Warrenville, IL 60555-3845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 19/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036123834 | (05) | IL |
206147 | MEDICARE GROUP (01) | IL |
206147133 | MEDICARE INDIVIDUAL (01) | IL |
P01179010 | RR MEDICARE (01) | IL |