Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD-22328 | IA |
N | 207RC0000X | Internist - Cardiovascular Disease | 22328 | IA |
NPI | 1184606915 |
---|---|
Provider Name | William J Wickemeyer |
First Address | Des Moines, IA 50314-3017 |
Second Address | Des Moines, IA 50314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 28/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0180240 | (05) | IA |
A01761 | (02) | IA |