Healthcare Provider Details

I. General information

NPI: 1144210337
Provider Name (Legal Business Name): WILLIAM MUDGE SLIGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 NORTHGATE CT STE 207 BLDG: NORTHGATE MEDICAL CENTER
NEW ALBANY IN
47150-6422
US

IV. Provider business mailing address

4130 DUTCHMANS LN STE 300
LOUISVILLE KY
40207-4713
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-1794
  • Fax: 502-238-1286
Mailing address:
  • Phone: 502-897-1794
  • Fax: 502-238-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29128
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20278
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: