Individual ProviderJacquelyn WitzkePhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansPractice Address200 Jefferson Ave SE, Grand Rapids, MI 49503-4502(616) 685-5000PECOS EnrollmentBased on the most recent information from CMS, provider Jacquelyn Witzke is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:10 AM.Profile DetailsProvider ID1851131361Provider TypeIndividualFull NameWitzke, JacquelynCredentialMDGenderFemaleSole ProprietorNoEnumeration Date5/31/2024Last Updated5/31/2024Contact InformationPractice LocationPractice Address200 Jefferson Ave SE, Grand Rapids, MI 49503-4502Phone(616) 685-5000FaxUnlisted FaxMailing LocationMailing Address200 Jefferson Ave SE, Grand Rapids, MI 49503-4502Phone(616) 685-5000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208100000XPrimaryDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense4351053379Michigan