Healthcare Provider Details

I. General information

NPI: 1669853552
Provider Name (Legal Business Name): CHRISTIAN WICHTERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 AUSTIN CENTER BLVD STE 300
AUSTIN TX
78731-3295
US

IV. Provider business mailing address

6210 E HWY 290
AUSTIN TX
78723-1098
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-8888
  • Fax: 512-406-7321
Mailing address:
  • Phone: 512-483-9596
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberT1260
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301500695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: