Healthcare Provider Details

I. General information

NPI: 1316507239
Provider Name (Legal Business Name): WIGLEY SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4717
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 TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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