Individual
BEVERLY S WICAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 325-2325
(651) 229-1718
Mailing address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 325-2325
(651) 229-1718
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
37563
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
637750500
—
MN
Enumeration date
10/16/2006
Last updated
07/07/2015
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