DR. GREGG B WICKSTROM (NPI# 1992729867) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992729867 |
| Entity Type | Individual |
| Full Name | DR. GREGG B WICKSTROM |
| Credential | M.D. |
| Practice Address |
4045 W Royal Dr Traverse City MI 49684-8965 |
| Practice Telephone | 2319350900 |
| Practice Fax Number | 2319350308 |
| Mailing Telephone | 2319350900 |
| Mailing Fax Number | 2319350308 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 4301030124 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
4045 W ROYAL DR |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-8965 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336141704 | Jeff Philip Burke | Physical Therapist | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2005-08-15 |
| 1417563073 | Madeline Adams | Nurse Practitioner | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2020-09-18 |
| 1043845928 | Kolleen Werly | Physician Assistant | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2020-03-11 |
| 1821599374 | Spencer Popp | Physician Assistant | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2018-02-21 |
| 1851832844 | Danielle Muszynski | Nurse Practitioner | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2017-03-10 |
| 1902233471 | Trisha Rae Zelinski | Physician Assistant | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2013-09-30 |
| 1124316096 | Janice Mary Cobb | Physical Therapist | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2011-07-13 |
| 1952691768 | Alisha Marie Cole | Physician Assistant | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2011-04-13 |
| 1306154505 | Karen Allison Miller | Specialist/Technologist | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2010-09-22 |
| 1114232279 | Shelly R King | Physical Therapy Assistant | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2010-08-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| 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 Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194763334 | Peter T Mcandrews IIi Do, PC | Orthopaedic Surgery | 5246 N Royal Dr, Suite A, Traverse City, MI 49684-6984 | 2006-06-02 |
| 1700852977 | Michael J Forness | Orthopaedic Surgery | 550 Munson Ave Ste 202, Traverse City, MI 49686-3580 | 2006-02-27 |
| 1790176972 | Eric B Lerche Do PC | Orthopaedic Surgery | 5246 N Royal Dr, Suite A, Traverse City, MI 49684-6984 | 2015-02-10 |
| 1942564489 | Michael Robert Morris | Orthopaedic Surgery | 701 W Front St Ste 100, Traverse City, MI 49684-2287 | 2012-06-29 |
| 1396030037 | Dr Justin J Hollander PC | Orthopaedic Surgery | 5246 N Royal Dr, Traverse City, MI 49684-6984 | 2011-06-10 |
| 1124273958 | Thomas V O'hagan | Orthopaedic Surgery | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2008-11-20 |
| 1669512000 | James P. Vanwagner D.o., P.C. | Orthopaedic Surgery | 5246 N Royal Dr, Suite A, Traverse City, MI 49684-6984 | 2007-02-07 |
| 1205995057 | John Robert Reineck | Orthopaedic Surgery | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2006-12-07 |
| 1205926268 | Christopher Robert Chuinard | Orthopaedic Surgery | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2006-10-13 |
| 1275637811 | Andrew S Boyce | Orthopaedic Surgery | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2006-09-12 |
| Find all providers in TRAVERSE CITY | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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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.