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Individual
ANDREW ROSS WICKMAN O'BRIEN
Active
Individual
ANDREW ROSS WICKMAN O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01078693A
IN
207RH0000X
Hematology (Internal Medicine) Physician
01078693A
IN
207RH0003X
Hematology & Oncology Physician
Primary
01078693A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11017065A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001339029
ANTHEM PTAN
IN
05
—
300013620
—
IN
Enumeration date
05/21/2013
Last updated
03/15/2025
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