Individual
LOUIS J. WICKAS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5238
(740) 441-8058
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5227
(740) 441-8058
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
20922
WV
207L00000X
Anesthesiology Physician
Primary
35-08-1701
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000193689
UNISON MEDICAID #
OH
01
—
000000261323
ANTHEM BCBS
—
01
—
000605261
MOUNTAIN STATE BCBS
—
05
—
0058894000
—
WV
01
—
050091556
RR MEDICARE
OH
01
—
0787180
MOLINA MEDICAID #
OH
05
—
0787180
—
OH
Enumeration date
06/17/2006
Last updated
01/11/2021
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