Provider Demographics
NPI:1306818562
Name:WITTROCK, JEANNE L (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:WITTROCK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:952-431-6966
Practice Address - Street 1:15290 PENNOCK LN - MAIL STOP 32200A
Practice Address - Street 2:HEALTH PARTNERS APPLE VALLEY CLINIC
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7163
Practice Address - Country:US
Practice Address - Phone:952-431-8500
Practice Address - Fax:952-431-6966
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-11-30
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Provider Licenses
StateLicense IDTaxonomies
MN29437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN151788100Medicaid
MN151788100Medicaid
D49067Medicare UPIN