Organization
DR. DALE WICKSTROM-HILL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE WICKSTROM-HILL DO (MD/PRESIDENT)
(352) 867-8898
Entity
Organization
Contact information
Practice address
200 AVENUE F NE, WINTER HAVEN, FL 33881-4131
(352) 867-8898
(352) 732-6282
Mailing address
PO BOX 198096, ATLANTA, GA 30384-8096
(352) 867-8898
(866) 665-2702
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
OS0006374
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003632900
—
FL
01
—
050066689
RAILROAD MEDICARE
FL
05
—
269252000
—
FL
01
—
80933
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/21/2006
Last updated
04/11/2014
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