Provider Demographics
NPI:1285033167
Name:WICHELHAUS, TILL PING (MD)
Entity Type:Individual
Prefix:DR
First Name:TILL
Middle Name:PING
Last Name:WICHELHAUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:STONY BROOK UNI HOSPITAL DEPT OF FAMILY MED
Mailing Address - Street 2:LEVEL 4, ROOM 050, HSC
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8461
Mailing Address - Country:US
Mailing Address - Phone:631-444-8430
Mailing Address - Fax:631-444-7552
Practice Address - Street 1:STONY BROOK UNI HOSPITAL DEPT OF FAMILY MED
Practice Address - Street 2:LEVEL 4, ROOM 050, HSC
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8461
Practice Address - Country:US
Practice Address - Phone:631-444-8430
Practice Address - Fax:631-444-7552
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2021-12-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program