Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Karl Theodore Wickstrom, MD

Individual provider Diagnostic Radiology Physician · NPI 1669476123

Karl Theodore Wickstrom, MD is a Diagnostic Radiology Physician in Prescott, Arizona. Licensed in Arizona. Registered with an NPI since 2005.

Licensed in
AZ
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

790 Gail Gardner Way
Prescott, AZ 86305-2337
Phone: (928) 776-9900
Fax: (928) 776-1444
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 21726 (AZ)

Record details

NPI number1669476123
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 10, 2005
Last updated in NPPESFebruary 28, 2013

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