Individual
LOUIS J. WICKAS III
Active
Individual
LOUIS J. WICKAS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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