Individual
DR. DEIRDRE A WICKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
304 1ST ST, ELK RAPIDS, MI 49629-9713
(248) 921-0901
Mailing address
304 1ST ST, ELK RAPIDS, MI 49629-9713
(248) 921-0901
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101010025
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140331
CARE CHOICES
MI
05
—
4263995
—
MI
05
—
4357788
—
MI
01
—
4465272
AETNA
MI
01
—
P76650
BLUE CROSS
MI
Enumeration date
06/04/2006
Last updated
01/02/2024
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