Doctor Name: | DR. JOHN STANLEY WICHMANN-WALCZAK |
NPI Number: | 1356333736 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD2647 |
Business Practice Address: | 94-837 Waipahu St Waipahu, HI - 967973320 |
Business Phone Number: | 8086713911 |
Business Fax Number: | 8086772720 |
Mailing Address: | 94-837 Waipahu St, WAIPAHU |
State: | HI |
Postal Code: | 967973320 |
Phone Number: | 8086713911 |
Fax Number: | 8086772720 |
NPI Enumeration Date: | 08/22/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD2647 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |