Individual
MARK T. WICHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2999 N MAYFAIR RD, WAUWATOSA, WI 53222-4306
(414) 479-7000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
37933
WI
207X00000X
Orthopaedic Surgery Physician
Primary
37933
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32253100
—
WI
01
—
P00682036
RR MEDICARE
WI
Enumeration date
12/29/2005
Last updated
07/26/2024
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