Provider Demographics
NPI:1386645976
Name:WIKLUND, DAN ALGOT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ALGOT
Last Name:WIKLUND
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 1:929 E MAIN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3116
Mailing Address - Country:US
Mailing Address - Phone:253-848-9563
Mailing Address - Fax:253-840-5519
Practice Address - Street 1:929 E MAIN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3116
Practice Address - Country:US
Practice Address - Phone:253-848-9563
Practice Address - Fax:253-840-5519
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018183207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1050863Medicaid
WA53031OtherDEPT OF LABOR AND IND
WA7095656Medicaid
WA53030OtherGROUP: DEPT L&I
WA53030OtherGROUP: DEPT L&I
WAA08654Medicare UPIN
WAAB09390Medicare ID - Type UnspecifiedGROUP