Karl Theodore Wickstrom, MD - Radiology in Prescott, AZ

Karl Theodore Wickstrom, MD is a Radiology - Diagnostic Radiology physician based in Prescott, Arizona. Karl Theodore Wickstrom is licensed to practice in Arizona (license number 21726) and his current practice location is 790 Gail Gardner Way, Prescott, Arizona. He can be reached at his office (for appointments etc.) via phone at (928) 776-9900.

NPI number for Karl Theodore Wickstrom is 1669476123 and his current mailing address is 790 Gail Gardner Way, Prescott, Arizona. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1669476123.

Contact Information

Karl Theodore Wickstrom, MD
790 Gail Gardner Way,
Prescott, AZ 86305-2337
(928) 776-9900
(928) 776-1444



Physician's Profile

Full NameKarl Theodore Wickstrom
GenderMale
SpecialityRadiology - Diagnostic Radiology
Location790 Gail Gardner Way, Prescott, Arizona
Accepts Medicare AssignmentsDoes not participate in Medicare Program. He may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1669476123
  • Provider Enumeration Date: 06/10/2005
  • Last Update Date: 02/28/2013

Medical Identifiers

Medical identifiers for Karl Theodore Wickstrom such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1669476123NPI-NPPES
446866MedicaidAZ

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2085R0202XRadiology - Diagnostic Radiology 21726 (Arizona)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Karl Theodore Wickstrom is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Karl Theodore Wickstrom, MD
790 Gail Gardner Way,
Prescott, AZ 86305-2337

Ph: (928) 776-9900
Karl Theodore Wickstrom, MD
790 Gail Gardner Way,
Prescott, AZ 86305-2337

Ph: (928) 776-9900

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› Verified 9 days ago


Radiology Doctors in Prescott, AZ

Timothy D Olthoff, DO
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 810 Whipple St, Prescott, AZ 86301
Phone: 928-771-7577    Fax: 928-458-2080
Dr. Bernard Sakowicz, M.D.
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 500 N Hwy 89, Northern Arizona Va Hcs, Prescott, AZ 86313
Phone: 928-445-4860    
Patrick K Hitchcock, MD
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 500 N Us Highway 89, Prescott, AZ 86313
Phone: 928-776-6004    
Bruce Medford Burtan, M.D.
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 2097 Summer Breeze Dr, Prescott, AZ 86303
Phone: 928-541-1714    
Dr. Mary M Poncel, M.D.
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 500 N Hwy 89, Northern Arizona Va Hcs, Prescott, AZ 86313
Phone: 928-445-4860    
Dr. Mohamed A Kirdani, M.D.
Radiology
Medicare: Not Enrolled in Medicare
Practice Location: 980 Willow Creek Rd, Prescott, AZ 86301
Phone: 928-443-0077    Fax: 928-443-0019
Michael J D'angelo, MD
Radiology
Medicare: Accepting Medicare Assignments
Practice Location: 1000 Ainsworth Dr, Suite 115, Prescott, AZ 86305
Phone: 928-778-1971    Fax: 928-443-8473

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