MEDICARE: RICHARD P WIKHOLM MD

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	207Y00000X	Otolaryngology Physician	G55811	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831198647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD P WIKHOLM MD

Provider Business Mailing Address
First Line	:	PO BOX 5427
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93456-5427
Country	:	US
Telephone Number	:	805-614-6250
Fax Number	:	805-614-9260

Provider Business Practice Location Address
First Line	:	116 S PALISADE DR
Second Line	:	STE 206
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-8904
Country	:	US
Telephone Number	:	805-614-9250
Fax Number	:	805-614-9260

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	10/01/2009

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