NPIMap

Individual provider Active NPI

Michael T Witkovsky, MD

  • Child & Adolescent Psychiatry Physician
  • Madison, WI
National Provider Identifier
1629044797
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
32400 Issued in WI
Practice address
301 Troy Dr
Madison, WI 53704-1521
Phone
(608) 301-1075
Fax
(608) 226-5429
NPI assigned
Feb 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 32400 WI
Child & Adolescent Psychiatry Physician 2084P0804X 32400 WI Primary

Addresses

Primary practice location

301 Troy Dr
Madison, WI 53704-1521

Mailing address

301 W Troy
Mendota Mental Health Institute
Madison, WI 53704-1187
Phone (608) 301-1075

Other identifiers 1

IdentifierTypeStateIssuer
31769600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32400WIMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Wisconsin CurrentSince Jan 18, 2011 Accepting new patients
County of Adams CurrentSince Feb 1, 2015 Accepting new patients
Psychology Clinic Inc. CurrentSince Aug 10, 2010 Accepting new patients
Winnebago Mental Health Institute CurrentSince Jan 18, 2011 Accepting new patients
Mendota Mental Health Institute PastSince Jan 18, 2011 Accepting new patients
Madison Psychiatric Associates, LTD. PastSince Apr 1, 1998 Accepting new patients
State of Wisconsin PastSince Jan 18, 2011 Accepting new patients
State of Wisconsin PastSince Jan 18, 2011 Accepting new patients

Locations

108 E North St
Friendship, WI 53934
Phone (608) 339-4505

301 Troy Dr
Madison, WI 53704
Phone (608) 301-1000

317 Knutson Dr
Madison, WI 53704
Phone (608) 301-9200

702 N Blackhawk Ave
Ste 212
Madison, WI 53705
Phone (608) 238-9991

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1629044797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W TROY",
            "address_2": "MENDOTA MENTAL HEALTH INSTITUTE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537041187",
            "telephone_number": "608-301-1075",
            "fax_number": "608-226-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 TROY DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537041521",
            "telephone_number": "608-301-1075",
            "fax_number": "608-226-5429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITKOVSKY",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "32400",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WI",
            "license": "32400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31769600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.