Provider Demographics
NPI:1942599543
Name:WICK, ALINA GRIGORIEVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:GRIGORIEVNA
Last Name:WICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ALINA
Other - Middle Name:BENA
Other - Last Name:LIVSHITS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13819 HANSON BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7608
Mailing Address - Country:US
Mailing Address - Phone:763-392-4001
Mailing Address - Fax:763-862-2091
Practice Address - Street 1:7373 FRANCE AVE S STE 202
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4551
Practice Address - Country:US
Practice Address - Phone:952-835-1311
Practice Address - Fax:952-428-0099
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57815207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine