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KARL THEODORE WICKSTROM M.D.
NPI 1669476123
Radiology - Diagnostic Radiology in Prescott, AZ

Active since June 10, 2005
790 GAIL GARDNER WAY, PRESCOTT, AZ 86305(928) 776-9900(928) 776-1444 Get Directions Write a Review

NPPES record last updated: February 28, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Karl Theodore Wickstrom M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KARL THEODORE WICKSTROM M.D. (NPI 1669476123) is an individual diagnostic radiology provider in Prescott, Arizona, licensed in Arizona (21726) and active in the NPI registry since June 2005.

NPPES Registry Identity

NPI1669476123
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameKARL THEODORE WICKSTROMCredential: M.D.
Location Address790 GAIL GARDNER WAYPrescott, AZ 86305-2337
Mailing Address790 Gail Gardner WayPrescott, AZ 86305-2337 · (928) 776-9900 · Fax (928) 776-1444
Phone(928) 776-9900
Fax(928) 776-1444
Sole ProprietorNo
Enumeration DateJune 10, 2005
Last NPPES UpdateFebruary 28, 2013
✔ NPI 1669476123 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
License✔ Licensed in AZ · 21726
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
790 GAIL GARDNER WAY, Prescott, AZ 86305
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Other Names 1

Other Name (5)Ted Wickstrom M.d.

Other Identifiers 3

Medicare PINZ90504AZ
Medicare UPINC63423AZ
Medicaid446866AZ

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SMI IMAGING LLC
Radiology (Diagnostic Radiology)
790 GAIL GARDNER WAY
PRESCOTT, AZ 86305
Yavapai County (928) 776-2660
MEDWISE PC
Radiology (Diagnostic Radiology)
790 GAIL GARDNER WAY
PRESCOTT, AZ 86305
Yavapai County (928) 776-9900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Karl Wickstrom's NPI number?

The NPI number for Karl Wickstrom is 1669476123. It was assigned to this individual provider in the NPPES registry on June 10, 2005. The provider is also known as Ted Wickstrom M.D..

Where is Karl Wickstrom located?

Karl Wickstrom practices at 790 Gail Gardner Way, Prescott, AZ 86305. The listed phone number is (928) 776-9900.

What is Karl Wickstrom's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

When was this NPI record last updated?

The NPPES record for Karl Wickstrom was last updated on February 28, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.