Healthcare Provider Details

I. General information

NPI: 1912155649
Provider Name (Legal Business Name): JEFFREY K WINGATE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2008
Last Update Date: 09/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 E 10 MILE RD STE 115
WARREN MI
48089-2048
US

IV. Provider business mailing address

13355 E 10 MILE RD STE 115
WARREN MI
48089-2048
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-9800
  • Fax: 586-755-9870
Mailing address:
  • Phone: 586-755-9800
  • Fax: 586-755-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY K WINGATE
Title or Position: OWNER
Credential: MD
Phone: 586-755-9800