Provider Demographics
NPI:1093838617
Name:WITZKE, JONATHAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:WITZKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7450 FRANCE AVE S STE 220
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4792
Mailing Address - Country:US
Mailing Address - Phone:952-925-1111
Mailing Address - Fax:952-922-3446
Practice Address - Street 1:7450 FRANCE AVE S STE 220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4792
Practice Address - Country:US
Practice Address - Phone:952-925-1111
Practice Address - Fax:952-922-3446
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN441452086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery