Provider Demographics
NPI:1124760202
Name:CHICOINE, WYATT ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:ANTHONY
Last Name:CHICOINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:W168N11237 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3239
Mailing Address - Country:US
Mailing Address - Phone:262-253-5060
Mailing Address - Fax:262-532-3467
Practice Address - Street 1:W168N11237 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3239
Practice Address - Country:US
Practice Address - Phone:262-253-5060
Practice Address - Fax:262-532-3467
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI8158721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine