Healthcare Provider Details

I. General information

NPI: 1659074383
Provider Name (Legal Business Name): MICHAELA WYCOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-2261
  • Fax: 515-643-5802
Mailing address:
  • Phone: 515-643-2261
  • Fax: 515-643-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR-12807
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: