Karl Theodore Wickstrom, M.D.
NPI 1669476123ActiveIndividual· Radiology, Diagnostic Radiology· Prescott, AZ
Radiology, Diagnostic Radiology (M.D.) in Prescott, Arizona, licensed in AZ, with an NPI issued in June 2005.
Overview
| NPI | 1669476123 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | M.D. |
| Sole proprietor | No |
| NPI issued | Jun 10, 2005 |
| Last updated in NPPES | Feb 28, 2013 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Radiology, Diagnostic Radiology Primary | 2085R0202X | 21726 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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