Individual
NEIL E WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2055 KIMBALL AVE STE 400, WATERLOO, IA 50702-5047
(319) 272-0000
(319) 272-1329
Mailing address
2055 KIMBALL AVE STE 400, WATERLOO, IA 50702-5047
(319) 272-0000
(319) 272-1329
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31935
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811974934
—
IA
05
—
2140343
—
IA
05
—
3140343
—
IA
01
—
P00287732
RR MEDICARE
IA
Enumeration date
12/29/2005
Last updated
04/04/2023
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