Provider Demographics
NPI:1235235433
Name:WITZKE, CHRISTIAN FEDERICO (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:FEDERICO
Last Name:WITZKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:WITZKE
Other - Last Name:SANZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:MOSS 3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-3930
Mailing Address - Fax:215-456-1432
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:MOSS 3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-3930
Practice Address - Fax:215-456-3533
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429681207RC0000X, 207RI0011X
MA234566207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102510300Medicaid
PA105852GQAMedicare PIN