Individual ProviderJacquelyn WitzkePhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansPractice Address235 Wealthy St SE, Grand Rapids, MI 49503-5247(616) 840-8000PECOS 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 8 days ago.Profile DetailsProvider ID1851131361Provider TypeIndividualFull NameWitzke, JacquelynCredentialMDGenderFemaleSole ProprietorNoEnumeration Date5/31/2024Last Updated6/20/2025Contact InformationPractice LocationPractice Address235 Wealthy St SE, Grand Rapids, MI 49503-5247Phone(616) 840-8000FaxUnlisted FaxMailing LocationMailing Address235 Wealthy St SE, Grand Rapids, MI 49503-5247Phone(616) 840-8000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208100000XPrimaryDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense4351053379Michigan