Provider Demographics
NPI:1154651727
Name:WITEK, MATTHEW EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:WITEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W JOHNSON ST APT 714
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3553
Mailing Address - Country:US
Mailing Address - Phone:215-806-4460
Mailing Address - Fax:
Practice Address - Street 1:309 W JOHNSON ST APT 714
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3553
Practice Address - Country:US
Practice Address - Phone:215-806-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI623712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology