Michael M Wick, M.D.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

G34509 Issued in CA

Practice address

2995 Woodside Rd
Ste 400
Woodside, CA 94062-2446

Phone

(650) 845-7711

NPI assigned

Apr 3, 2007

Last updated

Nov 29, 2022By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1801917950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 WOODSIDE RD",
            "address_2": "STE 400",
            "city": "WOODSIDE",
            "state": "CA",
            "postal_code": "940622446",
            "telephone_number": "650-845-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 WOODSIDE RD",
            "address_2": "STE 400",
            "city": "WOODSIDE",
            "state": "CA",
            "postal_code": "940622446",
            "telephone_number": "650-845-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICK",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MA",
            "license": "37261",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G34509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Village Doctor
• Kali Rose Tileston, MD
• Sarah M Vincenzo, MA, LICSW
• Virginia Warden, MS RN NP
• Norman Warren Weinstein, M.D.
• Woodside Village Pharmacy
• Amanda Yonkers, CO
• Joseph A Zammuto, DO

• Procedural Dermatology Physician in Woodside, CA
• Providers in Woodside, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.