Provider Demographics
NPI:1093752883
Name:WIK, DANIEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:WIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N 37TH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3283
Mailing Address - Country:US
Mailing Address - Phone:402-316-3250
Mailing Address - Fax:402-316-3252
Practice Address - Street 1:110 N 37TH ST
Practice Address - Street 2:STE 103
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3283
Practice Address - Country:US
Practice Address - Phone:402-316-3250
Practice Address - Fax:402-316-3252
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23401208100000X
WI47338-20208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE247651OtherMIDLANDS CHOICE
NE10026101300Medicaid
NEP00286103OtherRR
NE30304OtherBCBSNE
NEI36527Medicare UPIN
NE10026101300Medicaid