Provider Demographics
NPI:1811950769
Name:WITKE, CHRISTOPHER JACOB (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JACOB
Last Name:WITKE
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 1:221 13TH AVENUE PL NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2596
Mailing Address - Country:US
Mailing Address - Phone:828-324-1699
Mailing Address - Fax:828-324-0281
Practice Address - Street 1:221 13TH AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2596
Practice Address - Country:US
Practice Address - Phone:828-324-1699
Practice Address - Fax:828-324-0281
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45384-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34351500Medicaid
WI2005352OtherPHYSICIANS PLUS
NCP00715610OtherRAILROAD MEDICARE
WI60101OtherDEAN HEALTH PLAN
NC5911820Medicaid
NC2044570DMedicare Oscar/Certification
NC2073278AMedicare Oscar/Certification
WI34351500Medicaid
NC2044570EMedicare Oscar/Certification
NC2044570CMedicare Oscar/Certification
NC5911820Medicaid
NC2044570FMedicare Oscar/Certification
WI009754375Medicare PIN
WI080194818Medicare PIN
WIH80554Medicare UPIN