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Dr. Otto William Wickstrom III, MD
Specialist in Bloomington, Indiana
NPI 1487826939

Otto William Wickstrom III is a Specialist based in Bloomington, IN. Otto William Wickstrom III practices in Bloomington, IN and has the professional credentials of MD. The NPI Number for Otto William Wickstrom III is 1487826939 and holds a License No. MD61074238 (Indiana).

The current practice location address for Otto William Wickstrom III is 583 S Clarizz Blvd, Bloomington, IN and can be reached out via phone at 812-333-2663 and via fax at 812-349-9206.

Location: 583 S Clarizz Blvd, Bloomington, IN, 47401-5515
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1487826939
Provider Name
Otto William Wickstrom III
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
583 S Clarizz Blvd, Bloomington, IN, 47401-5515
Phone Number
812-333-2663
Fax Number
812-349-9206
Provider Enumeration Date
03/25/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200931500 05 IN
institution
Provider Business Practice Location Address Details
Address
583 S Clarizz Blvd
City
Bloomington
State
Indiana
Zip
47401-5515
Phone Number
812-333-2663
Fax Number
812-349-9206
person
Provider Business Mailing Address Details
Address
583 S Clarizz Blvd
City
Bloomington
State
Indiana
Zip
47401-5515
Phone Number
812-333-2663
Fax Number
812-349-9206
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
01065381A (Indiana)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Orthopedic Surgery
Speciality
-
Taxonomy
207X00000X
License No.
MD61074238 (Washington)
Definition
An orthopedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.
person
Provider's Taxonomy Details 3
Type
Allopathic & Osteopathic Physicians
Classification
Orthopedic Surgery
Speciality
Hand Surgery
Taxonomy
207XS0106X
License No.
MD61074238 (Washington)
Definition
An orthopedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist.
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