Larry A Wickless, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

5101005865 Issued in MI

Practice address

28080 Grand River Ave
Suite 306
Farmington Hills, MI 48336-5966

Phone

(248) 471-8982

Fax

(248) 426-7350

NPI assigned

Jan 24, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Oakland Gastroenterology Associates PC

  • Gastroenterology Physician
  • Farmington, MI
  • NPI 1316919616
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033189071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28080 GRAND RIVER AVE",
            "address_2": "SUITE 306",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483365966",
            "telephone_number": "248-471-8982",
            "fax_number": "248-426-7350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28080 GRAND RIVER AVE",
            "address_2": "SUITE 306",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483365966",
            "telephone_number": "248-471-8982",
            "fax_number": "248-426-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLESS",
        "first_name": "LARRY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "5101005865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ja'Nice Whorton
• Samantha Whtie
• Victoria Wiatrek
• Lance Christopher Wicker
• Mason Wicking
• Cheyanne Wicks
• Justyce Wicks
• Monet Widemon
• Amy Lynn Widenbaum, MSW,LMSW,CSW,ACSW
• Sarah Widing

• Gastroenterology Physician in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Gastroenterology Physician in Michigan

• 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.

Verify at the official NPI Registry.