Healthcare Provider Details

I. General information

NPI: 1124864848
Provider Name (Legal Business Name): EDGAR WILLIAM FICKE-ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 LAKELAND DR
CHIPPEWA FALLS WI
54729-1687
US

IV. Provider business mailing address

2403 FOLSOM ST
EAU CLAIRE WI
54703-2435
US

V. Phone/Fax

Practice location:
  • Phone: 715-726-9248
  • Fax: 715-726-2087
Mailing address:
  • Phone: 715-552-9780
  • Fax: 715-835-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8823-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: