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NPI Code Detail

MEDICARE: MELANIE P WICK MD

MEDICARE: MELANIE P WICK 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
1208000000XPediatrics PhysicianL7253TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
175-2616977-027OTHERTXTRICARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699741322
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE P WICK MD
Provider Business Mailing Address
First Line : PO BOX 846098
Second Line :
City : DALLAS
State : TX
Zip : 75284-6098
Country : US
Telephone Number : 903-324-6450
Fax Number :
Provider Business Practice Location Address
First Line : 706 TURTLE CREEK DR
Second Line :
City : TYLER
State : TX
Zip : 75701-1833
Country : US
Telephone Number : 903-595-3942
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2006
Last Update Date : 09/25/2017

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Directions to “ MELANIE P WICK MD” Practice Location

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