Active NPI
Mark Witeck, M.D.
- Laboratory Management Specialist/Technologist
- Kenosha, WI
National Provider Identifier
1811146897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Laboratory Management Specialist/Technologist
- License
- 28122-20
- Practice address
- 8600 Sheridan Rd Ste 600
Kenosha Div of Health Lab
Kenosha, WI 53143-6515 - Phone
- (262) 605-6700
- Fax
- (262) 605-6715
- NPI assigned
- Sep 15, 2008
- 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 |
|---|---|---|---|---|
| Laboratory Management Specialist/Technologist | 246QL0900X | 28122-20 | WI | Primary |
Addresses
Primary practice location
8600 Sheridan Rd Ste 600
Kenosha Div of Health Lab
Kenosha, WI 53143-6515
Mailing address
8600 Sheridan Rd Ste 600
Kenosha Div of Health Lab
Kenosha, WI 53143-6515
Phone (262) 605-6700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32924500 | Medicaid | WI |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28122-20 | WI | MD | Laboratory Management Specialist/Technologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kenosha County Division of Health | Past | Accepting new patients | |
| Kenosha County Div of Public Health | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Medical Laboratory
- Kenosha, WI
- NPI 1477744472
-
- Public Health or Welfare Agency
- Kenosha, WI
- NPI 1467643130
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221436800000",
"number": "1811146897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8600 SHERIDAN RD STE 600",
"address_2": "KENOSHA DIV OF HEALTH LAB",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531436515",
"telephone_number": "262-605-6700",
"fax_number": "262-605-6715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8600 SHERIDAN RD STE 600",
"address_2": "KENOSHA DIV OF HEALTH LAB",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531436515",
"telephone_number": "262-605-6700",
"fax_number": "262-605-6715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITECK",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-15",
"last_updated": "2008-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "246QL0900X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Laboratory Management",
"state": "WI",
"license": "28122-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32924500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.