MEDICARE: DR. PATRICIA ANN WALICKE M.D., PH. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	G49487	CA

General Provider Information

NPI Number	:	1114047099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA ANN WALICKE M.D., PH. D.

Provider Business Mailing Address
First Line	:	10 KINGS RD
Second Line	:
City	:	BRISBANE
State	:	CA
Zip	:	94005-1642
Country	:	US
Telephone Number	:	415-656-4358
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 KINGS RD
Second Line	:
City	:	BRISBANE
State	:	CA
Zip	:	94005-1642
Country	:	US
Telephone Number	:	415-656-4358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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