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General NPI Number Information
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NPI Number | 1770779225
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Entity Type | Individual
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Provider Name | CHRISTOPHER G WICHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 2875 TINA AVENUE, SUITE 101
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City | MISSOULA
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State | MT
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Zip | 59808
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Country | US
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Telephone | 406-728-3366
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Fax | 406-728-0651
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Provider Business Mailing Address
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Address Line | 2875 TINA AVENUE, SUITE 101
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City | MISSOULA
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State | MT
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Zip | 59808
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Country | US
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Telephone | 406-728-3366
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Fax | 406-728-0651
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 6359072-1205
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License Number State | UT
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