Wicklund, Brian Montgomery

Wicklund, Brian Montgomery is an individual health care provider with primary practice located at 2401 Gillham Rd , Kansas City MO 64108-4619. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology, which is considered as his primary health care specialty. Wicklund, Brian Montgomery can be contacted via phone (816) 234-3000.

Contact Information

Primary practice address
2401 Gillham Rd Kansas City MO 64108-4619
Phone: (816) 234-3000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology 2080P0207X R8H41 Missouri
Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology 2080P0207X 04-23044 Kansas

Profile Details

NPI number 1275599417
LBN Legal business name Wicklund, Brian Montgomery
Credentials MDCM, MPH
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2006
Last updated Jun 17th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275599417 NPPES
Missouri MEDICAID 202615506
Missouri MEDICAID 100117230A

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