DR. DEIRDRE A WICKHAM (NPI# 1740228279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740228279 |
| Entity Type | Individual |
| Full Name | DR. DEIRDRE A WICKHAM |
| Credential | DO |
| Practice Address |
39475 Lewis Dr Ste 270 Novi MI 48377-2904 |
| Mailing Address |
26901 Beaumont Blvd Ste 3d Southfield MI 48033-3849 |
| Practice Telephone | 2483249024 |
| Practice Fax Number | 2483249025 |
| Mailing Telephone | 9475221862 |
| Mailing Fax Number | 9475220307 |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2020-10-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 5101010025 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | CARE CHOICES | 140331 | 01 |
| MI | 4263995 | 05 | |
| MI | 4357788 | 05 | |
| MI | AETNA | 4465272 | 01 |
| MI | BLUE CROSS | P76650 | 01 |
| Street Address |
39475 LEWIS DR STE 270 |
| City | NOVI |
| State | MI |
| Zip Code | 48377-2904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861805590 | Emily Caitlin Zajac | Obstetrics & Gynecology | 39475 Lewis Dr Ste 270, Novi, MI 48377-2904 | 2014-06-10 |
| 1609810530 | Angela Christine Fleming | Obstetrics & Gynecology | 39475 Lewis Dr Ste 270, C/o Essential Gynecology & Obstetrics, Novi, MI 48377-2904 | 2006-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679075758 | Andrea Campbell | Nurse Practitioner | 44000 W 12 Mile Rd Ste 113, Novi, MI 48377 | 2018-03-05 |
| 1811421928 | Michigan Eye and Contact Lens Pllc | Optometrist | 42081 14 Mile Road, Novi, MI 48377 | 2017-04-14 |
| 1336695691 | Deanna Lynne Klein | Speech-Language Pathologist | 44140 Fox Run Road, Novi, MI 48377 | 2016-08-28 |
| 1871940973 | Jaime Durante | Nurse Practitioner | 44070 W. 12 Mile Rd, Suite 100, Novi, MI 48377 | 2016-05-18 |
| 1508225624 | Trilogy Healthcare of Oakland II, LLC | Skilled Nursing Facility | 41795 W 12 Mile Road, Novi, MI 48377 | 2016-02-17 |
| 1144688854 | Hussein Azzam | Allergy & Immunology | 46325 W 12 Mile Rd Ste 215, Novi, MI 48377 | 2016-02-09 |
| 1598120164 | Nova Counseling Services Inc. | Counselor | 41650 Clemens Circle, Novi, MI 48377 | 2015-12-23 |
| 1891174587 | Reem Mariam Mansour | Occupational Therapist | 44125 West 12 Mile Rd E-123, Novi, MI 48377 | 2015-05-27 |
| 1154747095 | Ali Hassan Ismail | Dentist | 41920 Wolfe Pass, Novi, MI 48377 | 2014-03-17 |
| 1558703876 | Twelve Oaks Orthodontics Pllc | Dentist | 44110 W 12 Mile Rd, Suite 100, Novi, MI 48377 | 2013-07-29 |
| Find all providers in zip 48377 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407210883 | Amanda Nicole King | Obstetrics & Gynecology | 46325 W 12 Mile Rd Ste 250, Novi, MI 48377-2461 | 2016-04-11 |
| 1699746537 | Women's Health Consultants, Plc | Obstetrics & Gynecology | 46325 W 12 Mile Road, Suite 250, Novi, MI 48377 | 2006-01-30 |
| 1740275130 | Karol L Otteman | Obstetrics & Gynecology | 27780 Novi Rd, Suite 108, Novi, MI 48377-3401 | 2005-09-13 |
| 1659372118 | Lester James Voutsos | Obstetrics & Gynecology | 46325 W Twelve Mile Road, Suite 250, Novi, MI 48377 | 2005-08-09 |
| 1851399919 | Paul Hakim | Obstetrics & Gynecology | 26850 Providence Parkway, Suite 500, Novi, MI 48374 | 2005-07-13 |
| 1750388930 | Jennifer Ilene Kaplan | Obstetrics & Gynecology | 46325 W. Twelve Mile Road, Suite 250, Novi, MI 48377 | 2005-07-05 |
| 1861805590 | Emily Caitlin Zajac | Obstetrics & Gynecology | 39475 Lewis Dr Ste 270, Novi, MI 48377-2904 | 2014-06-10 |
| 1982029344 | Virginia Battel | Obstetrics & Gynecology | 46325 W 12 Mile Rd, Suite 250, Novi, MI 48377-2456 | 2014-02-21 |
| 1740542141 | Jennifer Debra Borson | Obstetrics & Gynecology | 46325 W 12 Mile Rd, Suite 250, Novi, MI 48377-2456 | 2012-06-12 |
| 1528326741 | Chungsuk K. Park | Obstetrics & Gynecology | 25676 Island Lake Dr, Novi, MI 48374-2175 | 2012-04-25 |
| Find all providers in NOVI | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.