Individual
LARYSA TARASHEVSKA WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1500 E MEDICAL CENTER DR, 1ST FLOOR TAUBMAN CENTER RECP D, ANN ARBOR, MI 48109-5318
(734) 936-4210
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301089772
MI
2080P0210X
Pediatric Nephrology Physician
Primary
4301089772
MI
Other
Enumeration date
08/06/2007
Last updated
10/20/2020
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