Provider Demographics
NPI:1861481699
Name:WITTE, PATRICIA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RUTH
Last Name:WITTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2637
Mailing Address - Country:US
Mailing Address - Phone:608-257-9700
Mailing Address - Fax:608-258-9042
Practice Address - Street 1:675 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2637
Practice Address - Country:US
Practice Address - Phone:608-257-9700
Practice Address - Fax:608-258-9042
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020452207Q00000X
WI38146-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48535729Medicaid
AZ764581Medicaid
CO57933529Medicaid
NM48535729Medicaid
320059Medicare Oscar/Certification
8HBH21Medicare PIN
CO57933529Medicaid