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General NPI Number Information
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NPI Number | 1174621114
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Entity Type | Organization
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Legal Business Name | DR. DALE WICKSTROM-HILL PA
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 200 AVENUE F NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4131
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Country | US
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Telephone | 352-867-8898
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Fax | 352-732-6282
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Provider Business Mailing Address
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Address Line | PO BOX 198096
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City | ATLANTA
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State | GA
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Zip | 30384-8096
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Country | US
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Telephone | 352-867-8898
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Fax | 866-665-2702
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | DR. DALE WICKSTROM-HILL
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Credential | DO
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Telephone | 352-867-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | OS0006374
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License Number State | FL
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