Larry A Wickless
Gastroenterologist
28080 Grand River Ave Suite 306
Farmington Hills
, Michigan 48336-5966
Larry A Wickless
Gastroenterologist
28080 Grand River Ave Suite 306
Farmington Hills
, Michigan 48336-5966
(248) 426-7350
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About
Features
Specialties
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Larry A Wickless
- 28080 Grand River Ave Suite 306
- Farmington Hills, MI
- Zip : 48336-5966
- Fax : (248) 426-7350
- Phone : (248) 471-8982
Second Address
- Larry A Wickless
- 28080 Grand River Ave Suite 306
- Farmington Hills, MI
- Zip : 48336-5966
- Fax : (248) 426-7350
- Phone : (248) 471-8982
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RG0100X | Gastroenterologist | 5101005865 | MI |
National Provider Identifier
| NPI | 1033189071 |
|---|---|
| Provider Name | Larry A Wickless |
| First Address | Farmington Hills, MI 48336-5966 |
| Second Address | Farmington Hills, MI 48336-5966 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/01/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| B47677 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.