Provider Demographics
NPI:1962227017
Name:WITZLIB, CHRISTOPHER WILLIAM
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:WITZLIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2498
Mailing Address - Country:US
Mailing Address - Phone:414-559-6779
Mailing Address - Fax:262-268-1693
Practice Address - Street 1:1651 WILLOW DR
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2498
Practice Address - Country:US
Practice Address - Phone:414-559-6779
Practice Address - Fax:262-268-1693
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus