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NPI Code Detail

MEDICARE: DAREN J WICKUM M.D.

MEDICARE: DAREN J WICKUM M.D.
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
1207X00000XOrthopaedic Surgery Physician44501MN

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 : 1073587606
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAREN J WICKUM M.D.
Provider Business Mailing Address
First Line : 710 COMMERCE DR STE 200
Second Line :
City : WOODBURY
State : MN
Zip : 55125-4925
Country : US
Telephone Number : 651-968-5042
Fax Number : 651-968-5904
Provider Business Practice Location Address
First Line : 3580 ARCADE ST
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-7135
Country : US
Telephone Number : 651-968-5770
Fax Number : 651-968-5775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 07/02/2015

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