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NPI Code Detail

MEDICARE: MR. CURTIS G WICKRE MD

MEDICARE: MR. CURTIS G WICKRE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology PhysicianMD00019812WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033102116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CURTIS G WICKRE MD
Provider Business Mailing Address
First Line : PO BOX 12
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-0012
Country : US
Telephone Number : 406-543-7271
Fax Number :
Provider Business Practice Location Address
First Line : 500 W BROADWAY ST
Second Line : 4TH FLOOR
City : MISSOULA
State : MT
Zip : 59802-4008
Country : US
Telephone Number : 406-327-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 09/01/2015

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