Wickstrom, Otto William

Wickstrom, Otto William is an individual health care provider with primary practice located at 583 S Clarizz Blvd , Bloomington IN 47401-5515. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Hand Surgery, Other Service Providers / Specialist. Allopathic & Osteopathic Physicians / Hand Surgery is his primary health care specialty. Wickstrom, Otto William can be contacted via phone (812) 333-2663.

Contact Information

Primary practice address
583 S Clarizz Blvd Bloomington IN 47401-5515
Phone: (812) 333-2663
Fax: (812) 349-9206
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X MD61074238 Washington
Allopathic & Osteopathic Physicians / Hand Surgery 207XS0106X MD61074238 Washington
Other Service Providers / Specialist 174400000X 01065381A Indiana

Profile Details

NPI number 1487826939
LBN Legal business name Wickstrom, Otto William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 25th, 2008
Last updated Apr 29th, 2021 - about 3 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 1487826939 NPPES
Indiana MEDICAID 200931500

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