Individual
JOHN M WICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
703 S AMERICANA BLVD STE 120, BOISE, ID 83702-6754
(208) 894-5543
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 887-6813
(208) 887-6884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8339
ID
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
M-8339
ID
Other
Enumeration date
05/18/2006
Last updated
10/03/2017
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