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General NPI Number Information
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NPI Number | 1225261324
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Entity Type | Individual
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Provider Name | ELIOT MARTIN WICKLIFF M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE DEPARTMENT OF ANESTHESIOLOGY
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-8700
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Fax | 414-259-1522
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Provider Business Mailing Address
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Address Line | PO BOX 18962
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City | BELFAST
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State | ME
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Zip | 04915-4084
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Country | US
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Telephone | 800-566-5050
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Fax | 254-537-6869
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 125057068
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 56537
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | Q3833
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License Number State | TX
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