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

Larysa Tarashevska Wickman, MD

Individual provider Pediatrics Physician · NPI 1063603082

Larysa Tarashevska Wickman, MD is a Nephrology in Ann Arbor, Michigan. Qualified in 1996, 30 years ago. Practices with Beaumont Medical Group- Specialty Services, a 858-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
30
Licensed in
MI
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1500 E Medical Center Dr 1st Fl Taubman Center Recp D
Ann Arbor, MI 48109-5318
Phone: (734) 936-4210
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3535 W 13 Mile Rd Ste 707, Royal Oak, MI 48073-6770 — (248) 551-0487

Specialties & licences

Pediatric Nephrology Physician (primary) Taxonomy 2080P0210X · Licence 4301089772 (MI)
Pediatrics Physician Taxonomy 208000000X · Licence 4301089772 (MI)

Record details

NPI number1063603082
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 6, 2007
Last updated in NPPESOctober 20, 2020
Certification dateOctober 20, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEPHROLOGY
Also practisesPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Group practice Beaumont Medical Group- Specialty Services — 858 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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