Individual
DR. SUSAN LEE WICKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13737 N 92ND ST, SCOTTSDALE, AZ 85260-7434
(480) 301-8000
Mailing address
13737 N 92ND ST, SCOTTSDALE, AZ 85260-7434
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20950
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441163
—
AZ
01
—
86080015085259A266
TRIWEST
AZ
01
—
86080015085260A010
TRIWEST
AZ
Enumeration date
12/12/2005
Last updated
10/31/2007
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