Individual
CORNELIUS W WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
49 LEAVENWORTH ST, SUITE 200, WATERBURY, CT 06702-2115
(602) 317-6874
(602) 953-7767
Mailing address
11811 N TATUM BLVD, SUITE 3031, PHOENIX, AZ 85028-1614
(602) 317-6874
(602) 953-7767
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
013709
CT
Other
Enumeration date
03/03/2006
Last updated
10/19/2007
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