Active NPI
Thomas Arno Wittkopp, M.D.
- Psychiatry Physician
- Anoka, MN
National Provider Identifier
1053381657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 19817
- Practice address
- 3301 7TH Ave
Anoka, MN 55303-4516 - Phone
- (651) 431-5000
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 19817 | MN | Primary |
Addresses
Primary practice location
3301 7TH Ave
Anoka, MN 55303-4516
Mailing address
345 Southshore Dr
Greenback, TN 37742-2301
Phone (218) 831-1535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118773200 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512000000000",
"number": "1053381657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 SOUTHSHORE DR",
"city": "GREENBACK",
"state": "TN",
"postal_code": "377422301",
"telephone_number": "218-831-1535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 7TH AVE",
"city": "ANOKA",
"state": "MN",
"postal_code": "553034516",
"telephone_number": "651-431-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTKOPP",
"first_name": "THOMAS",
"middle_name": "ARNO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2017-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "19817",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "118773200",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.