Provider Demographics
NPI:1528178183
Name:WITZKE, BERNHARDT HENDRICK (CSA)
Entity type:Individual
Prefix:MR
First Name:BERNHARDT
Middle Name:HENDRICK
Last Name:WITZKE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
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Mailing Address - Street 1:43742 PERIGNON DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1929
Mailing Address - Country:US
Mailing Address - Phone:586-803-0809
Mailing Address - Fax:
Practice Address - Street 1:43742 PERIGNON DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1929
Practice Address - Country:US
Practice Address - Phone:586-803-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical