OTTO WILLIAM WICKSTROM

BLOOMINGTON, IN
NPI1487826939
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207XS0106X Orthopaedic Surgery, Hand Surgery
(Licence: WA  MD61074238)
Additional Taxonomies207X00000X Orthopaedic Surgery
(Licence: WA  MD61074238)
174400000X Specialist
(Licence: IN  01065381A)
Enumeration Date2008-03-25
Last Update Date2021-04-29
Business Address
Dr. OTTO WILLIAM WICKSTROM M.D.
583 S CLARIZZ BLVD
BLOOMINGTON, IN 47401-5515
Phone number: 812-333-2663
Mailing Address
Dr. OTTO WILLIAM WICKSTROM M.D.
583 S CLARIZZ BLVD
BLOOMINGTON, IN 47401-5515
Phone number: