Healthcare Provider Details

I. General information

NPI: 1326414343
Provider Name (Legal Business Name): WIGLEY FOOT AND ANKLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 NE 163RD ST
NORTH MIAMI BEACH FL
33162
US

IV. Provider business mailing address

1595 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4717
US

V. Phone/Fax

Practice location:
  • Phone: 305-895-9528
  • Fax: 786-332-3242
Mailing address:
  • Phone: 305-895-9528
  • Fax: 786-332-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3625
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN WIGLEY IV
Title or Position: OWNER
Credential: DPM
Phone: 305-895-9528