| Doctor Name: | MR. RALPH WIKTOR |
| NPI Number: | 1285674044 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 5601003281 |
| Business Practice Address: | 11400 Joseph Campau St Hamtramck, MI - 482123041 |
| Business Phone Number: | 3133665500 |
| Business Fax Number: | 3133665505 |
| Mailing Address: | 2861 Lake Charnwood Dr, TROY |
| State: | MI |
| Postal Code: | 480982120 |
| Phone Number: | 3134342439 |
| Fax Number: | 2482509566 |
| NPI Enumeration Date: | 06/08/2006 |
| NPI Last Update Date: | 09/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601003281 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |