DR. JUSTIN EDWARD WITTKOPF (NPI# 1043460850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043460850 |
| Entity Type | Individual |
| Full Name | DR. JUSTIN EDWARD WITTKOPF |
| Credential | M.D. |
| Practice Address |
8500 75th St Ste 102 Kenosha WI 53142-8213 |
| Mailing Address |
2885 N Mayfair Rd Wauwatosa WI 53222-4404 |
| Practice Telephone | 4147716780 |
| Practice Fax Number | 4142382424 |
| Mailing Telephone | 4147716780 |
| Mailing Fax Number | 4142382424 |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2019-07-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 036-123362 | IL | Allopathic & Osteopathic Physicians |
| N | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
036123362 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1275521288 | 05 |
| Street Address |
8500 75TH ST STE 102 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-8213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538127816 | Mri & Imaging of Wisconsin Inc | Radiology | 8500 75th St, Suite 106, Kenosha, WI 53142-8213 | 2006-05-03 |
| 1578956231 | Molly K. Slaber | Physician Assistant | 8500 75th St, Suite 102, Kenosha, WI 53142-8213 | 2015-03-05 |
| 1649519299 | Children's Hospital of Wisconsin | Pediatrics | 8500 75th St, Kenosha, WI 53142-8213 | 2013-02-01 |
| 1649583188 | Alpha Medical Imaging Inc | Clinic/Center | 8500 75th St, Suite 106, Kenosha, WI 53142-8213 | 2010-07-26 |
| 1912036419 | Herslof's, Inc | Technician/Technologist | 8500 75th St, Suite 103, Kenosha, WI 53142-8213 | 2007-03-02 |
| 1013920297 | Kristen Volkman | Pediatrics | 8500 75th St, Suite 101, Kenosha, WI 53142-8213 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114248028 | Colleen Plein | Otolaryngology | 6127 Green Bay Rd Ste 100, Kenosha, WI 53142-2941 | 2010-06-15 |
| 1740364132 | Jeanne S. Vedder M.d Sc | Otolaryngology | 1400-75 Street, Suite 4, Kenosha, WI 53143-1522 | 2006-10-24 |
| 1538168752 | Jeanne Sue Vedder | Otolaryngology | 1400-75 Th Street, Suite 4, Kenosha, WI 53143-1522 | 2005-07-19 |
| 1760800718 | Kathryn Hoppe | Otolaryngology | 3400 Market Ln, Kenosha, WI 53144-3430 | 2014-04-06 |
| 1417394602 | Jason David Talmadge | Otolaryngology | 3400 Market Ln, Kenosha, WI 53144-3430 | 2013-05-28 |
| 1578650164 | Ear Nose and Throat Family Clinic of Wisconsin Sc | Otolaryngology | 6127 Green Bay Rd, Suite 100, Kenosha, WI 53142-2946 | 2006-10-06 |
| 1265529853 | Hilel Swerdlin | Otolaryngology | 6127 Green Bay Rd, Suite 100, Kenosha, WI 53142-2946 | 2006-10-06 |
| 1841212115 | Terry C. Liu | Otolaryngology | 10400 75th St, Kenosha, WI 53142-7884 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972104156 | Alliance Ent and Hearing Center, Sc | Otolaryngology | 2524 E Webster Place, Suite 201, Milwaukee, WI 53211-4257 | 2020-11-04 |
| 1962969915 | Alliance Ent & Hearing Center, S.c. | Otolaryngology | 2500 W Layton Ave Ste 230, Milwaukee, WI 53221-5421 | 2019-02-26 |
| 1851822076 | Fort Health Care Inc | Otolaryngology | 123 Hospital Dr Suite 106a, Watertown, WI 53098 | 2017-03-21 |
| 1184010977 | Chad Michael Ennis | Otolaryngology | 1 S Park St Fl 6, Madison, WI 53715-1375 | 2015-04-08 |
| 1487055133 | Sam Khalili | Otolaryngology | 2801 W Kinnickinnic River Pkwy # 680, Milwaukee, WI 53215 | 2014-09-12 |
| 1760803795 | Gary Miller | Otolaryngology | 3467 Northwood Rd, Suamico, WI 54313-8250 | 2013-12-17 |
| 1629320007 | Peter Uy Lee | Otolaryngology | 1341 Boundary Rd, Middleton, WI 53562-3843 | 2012-10-09 |
| 1700145091 | Kenneth Brian Lewoczko | Otolaryngology | 600 Highland Ave., H4/831, Uw Hospital and Clinics, Madison, WI 53792 | 2012-05-08 |
| 1962768267 | Christopher Joseph Lee | Otolaryngology | 500 W. Drexel Ave, Suite 300, Oak Creek, WI 53154-2060 | 2012-04-11 |
| 1871814715 | Norval Eldred Bernhardt | Otolaryngology | 9 Holt Ct, Madison, WI 53719-3036 | 2010-06-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.