Individual
DANIEL J WICKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3920 ST FRANCIS WAY, SUITE 110, LAFAYETTE, IN 47905-4917
(765) 428-5800
(765) 428-5802
Mailing address
3920 ST FRANCIS WAY, SUITE 110, LAFAYETTE, IN 47905-4917
(765) 428-5800
(765) 428-5802
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01034216A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232110
—
IN
Enumeration date
09/07/2005
Last updated
10/04/2011
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