Provider Demographics
NPI:1619953627
Name:WITTE, MICHAEL C (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:WITTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7900
Mailing Address - Fax:515-643-7901
Practice Address - Street 1:411 LAUREL ST STE A120
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3027
Practice Address - Country:US
Practice Address - Phone:515-643-7900
Practice Address - Fax:515-643-7901
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02210207RP1001X, 207RC0200X
IADO-02210207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18767OtherMIDLAND'S CHOICE
IAIA0102OtherUHC OF THE RIVER VALLEY
IA25096OtherWELLMARK
IA0043034Medicaid
IA73009OtherCOVENTRY
IA852826OtherUNITED HEALTHCARE
IA73009OtherCOVENTRY
IA18767OtherMIDLAND'S CHOICE