Larysa Tarashevska Wickman
Pediatrician Pediatric Nephrologist
1500 E Medical Center Dr 1st Floor Taubman Center Recp D
Ann Arbor
, Michigan 48109-5318
Larysa Tarashevska Wickman
Pediatrician Pediatric Nephrologist
1500 E Medical Center Dr 1st Floor Taubman Center Recp D
Ann Arbor
, Michigan 48109-5318
(734) 936-2047
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About
Features
Specialties
- Pediatrician
- Pediatric Nephrologist
Languages spoken
- English
Location
First Address
- Larysa Tarashevska Wickman
- 3621 S State St 700 Kms Place
- Ann Arbor, MI
- Zip : 48108
- Phone : (734) 936-2047
Second Address
- Larysa Tarashevska Wickman
- 1500 E Medical Center Dr 1st Floor Taubman Center Recp D
- Ann Arbor, MI
- Zip : 48109-5318
- Phone : (734) 936-4210
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 208000000X | Pediatrician | 4301089772 | MI |
| Y | 2080P0210X | Pediatric Nephrologist | 4301089772 | MI |
National Provider Identifier
| NPI | 1063603082 |
|---|---|
| Provider Name | Larysa Tarashevska Wickman |
| First Address | Ann Arbor, MI 48108 |
| Second Address | Ann Arbor, MI 48109-5318 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/08/2007 |
| Last Update Date | 20/10/2020 |
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.