| NPI | 1447395330 |
|---|---|
| Former Legal Business Name | OTTO W WICKSTROM JR. M.D. INC. |
| Entity Type | Organization |
| Authorized Contact | OTTO W WICKSTROM Physician 812-372-2437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IN 01018161A) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |