Healthcare Provider Details

I. General information

NPI: 1235117524
Provider Name (Legal Business Name): JEFFREY K WINGATE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22720 WOODWARD AVE STE 207
FERNDALE MI
48220-2906
US

IV. Provider business mailing address

1221 BOWERS ST UNIT 2710
BIRMINGHAM MI
48012-7106
US

V. Phone/Fax

Practice location:
  • Phone: 248-396-7612
  • Fax:
Mailing address:
  • Phone: 248-228-0054
  • Fax: 248-566-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number4301088960
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036128599
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number04-42522
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: