| Doctor Name: | MR. CHAD MICHAEL WIKAN |
| NPI Number: | 1134482631 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ANP-C |
| License Number: | AP4499 |
| Business Practice Address: | 12409 W Indian School Rd Suite #b210 Avondale, AZ - 853929502 |
| Business Phone Number: | 6239359920 |
| Business Fax Number: | 6239359925 |
| Mailing Address: | 12409 W Indian School Rd, Suite #b210 AVONDALE |
| State: | AZ |
| Postal Code: | 853929502 |
| Phone Number: | 6239359920 |
| Fax Number: | 6239359925 |
| NPI Enumeration Date: | 06/19/2012 |
| NPI Last Update Date: | 06/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | AP4499 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |