Diane M Witek, M.D.
Individual provider Active NPI Family Medicine Physician · Jackson, WI
NPI 1316157779 · NPPES record last updated Apr 1, 2013
Key facts
- NPI
- 1316157779
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 52622 (WI)
- Practice address
- W225N16711 Cedar Park CT
Jackson, WI 53037-9222 - Phone
- (262) 677-1101
- Fax
- (262) 306-2964
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Wisconsin School of Medicine, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Froedtert Andthe Medical College of Wisconsin Community Physicians Inc
Practice addresses (Care Compare)
W180N8000 Town Hall Rd
Menomonee Falls, WI 53051-4002
Phone (262) 255-2500
Hospital & facility affiliations
- Commonheart Hospice
- St Josephs Community Hospital West Bend
- Cedar Lake Health and Rehab Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100913000725 | WI | Practitioner - Family Practice | 2668597733 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52622 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current | Accepting new patients | |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current |
Accepting new patients |
Locations
W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060
110 Lone Oak Ln
Hartford, WI 53027
Phone (262) 670-1800
W225N16711 Cedar Park Ct
Jackson, WI 53037
Phone (262) 323-9257
1701 Fond du Lac Ave
Kewaskum, WI 53040
Phone (262) 626-4616
W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500
1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990
1700 W Paradise Dr
West Bend, WI 53095
Phone (262) 334-3451
Interoperability endpoints
- dwitekmd125850@direct.froedtert.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 52622 | WI | Yes |
Addresses
Primary practice location
W225N16711 Cedar Park CT
Jackson, WI 53037-9222
Mailing address
1700 W Paradise Dr
West Bend, WI 53095-9795
Phone (262) 334-3451
Other providers in Jackson, WI
- West Bend Clinic
- West Bend Clinic, Inc.
- Heidi Lynette Wildauer
- Annastasia Louis Wischki
- Wisconsin Lutheran Child & Family Service
- Ashley Wittmann
- Sara Wollemann
- Collin David Zweifel
All providers in Jackson, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.