Provider Demographics
NPI:1619956547
Name:WITCIK, WILLIAM J (MD,)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:WITCIK
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 1:1236 E RUSHOLME ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2473
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-888-0499
Practice Address - Street 1:1236 E RUSHOLME ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2473
Practice Address - Country:US
Practice Address - Phone:563-324-2992
Practice Address - Fax:563-888-0499
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-29219207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1105999Medicaid
060032126OtherMEDICARE RAILROAD
IA51121Medicare PIN
IA1105999Medicaid