Individual
LARRY A WICKLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
28080 GRAND RIVER AVE, SUITE 306, FARMINGTON HILLS, MI 48336-5966
(248) 471-8982
(248) 426-7350
Mailing address
28080 GRAND RIVER AVE, SUITE 306, FARMINGTON HILLS, MI 48336-5966
(248) 471-8982
(248) 426-7350
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
5101005865
MI
Other
Enumeration date
01/24/2006
Last updated
07/08/2007
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