Individual
ANDREW ROSS WICKMAN O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8326 NAAB RD, INDIANAPOLIS, IN 46260-1920
(317) 871-0000
(317) 871-0010
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01078693A
IN
207RH0000X
Hematology (Internal Medicine) Physician
01078693A
IN
207RH0003X
Hematology & Oncology Physician
Primary
01078693A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11017065A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001339029
ANTHEM PTAN
IN
05
—
300013620
—
IN
Enumeration date
05/21/2013
Last updated
03/15/2025
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