Individual
PAUL T WICKLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17 EXCHANGE ST W, SUITE 222, SAINT PAUL, MN 55102-1045
(651) 224-7854
Mailing address
10 N OAKS RD, NORTH OAKS, MN 55127-6431
(651) 765-0070
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
19937
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
486372100
—
MN
Enumeration date
01/31/2006
Last updated
10/26/2010
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