Individual
DR. MARTIN B WICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4921 PARKVIEW PL, SAINT LOUIS, MO 63110-1032
(314) 362-4503
(314) 362-4566
Mailing address
660 S EUCLID AVE, C B 8111, SAINT LOUIS, MO 63110-1010
(314) 362-4503
(314) 362-4566
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
R3G96
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IL
Enumeration date
03/28/2006
Last updated
01/30/2018
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