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Individual

DR. DEAN J WICKEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
502 CABELA DR, TRIADELPHIA, WV 26059-1044
(304) 285-1996
Mailing address
PO BOX 642, PROSPECT, KY 40059-0642
(502) 472-6629

Taxonomy

Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
010701869B
IN
2086S0129X
Vascular Surgery Physician
29653
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201039920
IN
Enumeration date
06/09/2005
Last updated
04/21/2022
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