Active NPI
Stephen D Witzke, MD
- Family Medicine Physician
- Mason, MI
National Provider Identifier
1679678775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301063419
- Practice address
- 230 Temple St
Mason, MI 48854-1837 - Phone
- (517) 676-9066
- Fax
- (517) 676-3505
- NPI assigned
- Sep 13, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301063419 | MI | Primary |
Addresses
Primary practice location
230 Temple St
Mason, MI 48854-1837
Mailing address
PO Box 13008
Lansing, MI 48901-3008
Phone (517) 364-6253
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0803306661 | Other | MI | BCBS INDIVIDUAL PIN |
| 4327090 | Medicaid | MI | |
| 200000001051 | Other | MI | PHP PIN # |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301063419 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199059200000",
"number": "1679678775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13008",
"city": "LANSING",
"state": "MI",
"postal_code": "489013008",
"telephone_number": "517-364-6253",
"fax_number": "517-364-6204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 TEMPLE ST",
"city": "MASON",
"state": "MI",
"postal_code": "488541837",
"telephone_number": "517-676-9066",
"fax_number": "517-676-3505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITZKE",
"first_name": "STEPHEN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2007-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301063419",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDIVIDUAL PIN",
"identifier": "0803306661",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4327090",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP PIN #",
"identifier": "200000001051",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mason, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.