Provider Demographics
NPI:1538795448
Name:WICKLINE, ZACHARY SETH (DO)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SETH
Last Name:WICKLINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 N REVERE CT STE 4100
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7464
Mailing Address - Country:US
Mailing Address - Phone:303-724-6021
Mailing Address - Fax:720-724-4963
Practice Address - Street 1:1890 N REVERE CT STE 4100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7464
Practice Address - Country:US
Practice Address - Phone:303-724-6021
Practice Address - Fax:720-724-4963
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00722892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry