Doctor Name: | MARK WITACZACK |
NPI Number: | 1104962182 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 05-20132 |
Business Practice Address: | 629 S Plummer Chanute, KS - 66720 |
Business Phone Number: | 3163215900 |
Business Fax Number: | 3163214763 |
Mailing Address: | Po Box 662, CHANUTE |
State: | KS |
Postal Code: | 66720 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | 05-20132 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |