Active NPI
Mark Brent Wickman, MD
- Urology Physician
- North Miami, FL
National Provider Identifier
1013979186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 27814
- Practice address
- 888 NE 126TH St
Suite 100
North Miami, FL 33161-4964 - Phone
- (305) 895-3434
- Fax
- (305) 893-8288
- NPI assigned
- Apr 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 27814 | FL | Primary |
Addresses
Primary practice location
888 NE 126TH St
Suite 100
North Miami, FL 33161-4964
Mailing address
888 NE 126TH St
Suite 100
North Miami, FL 33161-4964
Phone (305) 895-3434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27814 | FL | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013979186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "888 NE 126TH ST",
"address_2": "SUITE 100",
"city": "NORTH MIAMI",
"state": "FL",
"postal_code": "331614964",
"telephone_number": "305-895-3434",
"fax_number": "305-893-8288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "888 NE 126TH ST",
"address_2": "SUITE 100",
"city": "NORTH MIAMI",
"state": "FL",
"postal_code": "331614964",
"telephone_number": "305-895-3434",
"fax_number": "305-893-8288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKMAN",
"first_name": "MARK",
"middle_name": "BRENT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "FL",
"license": "27814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.