Provider Demographics
NPI:1194922393
Name:WICHMAN, SCOTT E (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:WICHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W CLAIREMONT AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4566
Mailing Address - Country:US
Mailing Address - Phone:715-834-1555
Mailing Address - Fax:715-835-0263
Practice Address - Street 1:614 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1568
Practice Address - Country:US
Practice Address - Phone:920-849-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine