Active NPI
William Allen Wittchow, PA-C
- Physician Assistant
- Fridley, MN
National Provider Identifier
1124128525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9684
- Practice address
- 6341 University Ave NE
Fridley, MN 55432-4946 - Phone
- (763) 572-5710
- Fax
- (763) 586-5888
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9684 | MN | Primary |
Addresses
Primary practice location
6341 University Ave NE
Fridley, MN 55432-4946
Mailing address
6401 University Ave NE
Fridley, MN 55432-4341
Phone (763) 572-5710
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1029890 | Other | MN | PREFERRED ONE |
| 6605097 | Other | MN | MEDICA URGENT CARE |
| 251J4WI | Other | FM | BCBS OF MN |
| HP33986 | Other | MN | HEALTHPARTNERS |
| 104929 | Other | MN | UCARE MN |
| 25878 | Other | MN | AMERICA'S PPO |
| 0110259 | Other | MN | MEDICA |
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
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1124128525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6401 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554324341",
"telephone_number": "763-572-5710",
"fax_number": "763-571-3008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6341 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554324946",
"telephone_number": "763-572-5710",
"fax_number": "763-586-5888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTCHOW",
"first_name": "WILLIAM",
"middle_name": "ALLEN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "9684",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1029890",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA URGENT CARE",
"identifier": "6605097",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MN",
"identifier": "251J4WI",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP33986",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE MN",
"identifier": "104929",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "25878",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "0110259",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.