Provider Demographics
NPI:1497929343
Name:WICKHAM, MICHAEL QUINN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:QUINN
Last Name:WICKHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:316 S DUNWORTH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-6702
Mailing Address - Country:US
Mailing Address - Phone:559-625-0601
Mailing Address - Fax:559-625-1315
Practice Address - Street 1:316 S DUNWORTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-6702
Practice Address - Country:US
Practice Address - Phone:559-625-0601
Practice Address - Fax:559-625-1315
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200600790207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology