Provider Demographics
NPI:1821040007
Name:WICAL, SHELDEN C (DO)
Entity Type:Individual
Prefix:
First Name:SHELDEN
Middle Name:C
Last Name:WICAL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:GRAND LAKE PHYSICIAN PRACTICES
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-394-3387
Mailing Address - Fax:419-628-9501
Practice Address - Street 1:4463 STATE ROUTE 66
Practice Address - Street 2:MIAMI ERIE FAMILY PRACTICE & PEDIATRICE
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-8727
Practice Address - Country:US
Practice Address - Phone:419-628-3821
Practice Address - Fax:419-628-9501
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-03-24
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Provider Licenses
StateLicense IDTaxonomies
OH34007266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2236940Medicaid
OH9934723OtherMEDICARE GROUP PTAN
OH1104024546OtherNPI GROUP - MIAMI & ERIE FAMILY PRACTICE & PEDIATRICS