KARL THEODORE WICKSTROM M.D. NPI 1669476123

NPI Information

NPI: 1669476123
Provider Name: KARL THEODORE WICKSTROM, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
790 GAIL GARDNER WAY
PRESCOTT, AZ
ZIP 86305
Phone: (928) 776-9900
Get Directions

Karl Theodore Wickstrom, M.D. is a diagnostic radiology radiology in Prescott, AZ. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Karl Theodore Wickstrom, M.D. NPI is 1669476123. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

790 GAIL GARDNER WAY
PRESCOTT, AZ
ZIP 86305-337
Phone: (928) 776-9900
Fax: (928) 776-1444

The enumeration date for this NPI number is 6/10/2005 and was last updated on 2/28/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	21726	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	Z90504	MEDICARE PIN	ARIZONA
2	C63423	MEDICARE UPIN	ARIZONA
3	446866	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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