Individual
WILLIAM L WIXOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1000 S MAIN ST, TIPTON, IN 46072-9753
(765) 675-8397
(765) 675-6704
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02001810A
IN
208D00000X
General Practice Physician
02001810A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000851734
ANTHEM PIN
IN
05
—
200116990
—
IN
Enumeration date
07/05/2006
Last updated
03/08/2021
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