| Doctor Name: | LARRY A WICKLESS |
| NPI Number: | 1033189071 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 5101005865 |
| Business Practice Address: | 28080 Grand River Ave Suite 306 Farmington Hills, MI - 483365966 |
| Business Phone Number: | 2484718982 |
| Business Fax Number: | 2484267350 |
| Mailing Address: | 28080 Grand River Ave, Suite 306 FARMINGTON HILLS |
| State: | MI |
| Postal Code: | 483365966 |
| Phone Number: | 2484718982 |
| Fax Number: | 2484267350 |
| NPI Enumeration Date: | 01/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RG0100X |
| License Number: | 5101005865 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Gastroenterology |
| Taxonomy Definition: | An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |