Healthcare Provider Details

I. General information

NPI: 1316392889
Provider Name (Legal Business Name): DIONTE WIGGINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DR
MATTOON IL
61938-4644
US

IV. Provider business mailing address

1005 HEALTH CENTER DR STE 201
MATTOON IL
61938-4653
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2551
  • Fax: 217-258-2256
Mailing address:
  • Phone: 217-258-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036153297
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: