Individual
MITCHELL WICKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
271 E MAIN ST, HAZARD, KY 41701-1939
(606) 439-1316
(606) 435-0752
Mailing address
PO BOX 719, HAZARD, KY 41702-0719
(606) 439-1316
(606) 435-0752
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21790
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64217904
—
KY
Enumeration date
05/23/2005
Last updated
12/09/2010
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