Provider Demographics
NPI:1568450369
Name:WICKLINE, CINDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:L
Last Name:WICKLINE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1849 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7843
Mailing Address - Country:US
Mailing Address - Phone:719-344-5651
Mailing Address - Fax:719-344-5626
Practice Address - Street 1:1849 AUSTIN BLUFFS PKWY
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7843
Practice Address - Country:US
Practice Address - Phone:719-344-5651
Practice Address - Fax:719-344-5626
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31482207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31482OtherSTATE LICENSE
CO9000147090Medicaid
CO9000147090Medicaid
CO446698Medicare PIN
CO9000147090Medicaid