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Individual

STEVEN W WICKLUND

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1850 N CENTRAL AVE, STE 1600, PHOENIX, AZ 85004-4527
(602) 744-4765
(602) 744-4799
Mailing address
1850 N CENTRAL AVE, STE 1600, PHOENIX, AZ 85004-4527
(602) 744-4765
(602) 744-4799

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
23993
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
050076048
MEDICARE RAILROAD
05
358996
AZ
Enumeration date
04/21/2006
Last updated
10/28/2010
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