Healthcare Provider Details

I. General information

NPI: 1962426205
Provider Name (Legal Business Name): PATRICK ANTHONY WEGMAN I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W KING ST STE H
OWOSSO MI
48867-2100
US

IV. Provider business mailing address

911 W KING ST
OWOSSO MI
48867-2121
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8281
  • Fax: 989-723-6846
Mailing address:
  • Phone: 989-725-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301046310
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: