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Karl Theodore Wickstrom, MD
Diagnostic Radiology Physician in Prescott, Arizona
NPI 1669476123

Karl Theodore Wickstrom is a Diagnostic Radiology Physician based in Prescott, AZ and is specialized in Diagnostic Radiology. Karl Theodore Wickstrom practices in Prescott, AZ and has the professional credentials of MD. The NPI Number for Karl Theodore Wickstrom is 1669476123 and holds a License No. 21726 (Arizona).

The current practice location address for Karl Theodore Wickstrom is 790 Gail Gardner Way, Prescott, AZ and can be reached out via phone at 928-776-9900 and via fax at 928-776-1444.

Location: 790 Gail Gardner Way, Prescott, AZ, 86305-2337
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Provider Profile Details
NPI Number
1669476123
Provider Name
Karl Theodore Wickstrom
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
790 Gail Gardner Way, Prescott, AZ, 86305-2337
Phone Number
928-776-9900
Fax Number
928-776-1444
Provider Enumeration Date
06/10/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
446866 05 AZ
institution
Provider Business Practice Location Address Details
Address
790 Gail Gardner Way
City
State
Zip
86305-2337
Phone Number
928-776-9900
Fax Number
928-776-1444
person
Provider Business Mailing Address Details
Address
790 Gail Gardner Way
City
State
Zip
86305-2337
Phone Number
928-776-9900
Fax Number
928-776-1444
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
License No.
21726 (Arizona)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
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