Healthcare Provider Details

I. General information

NPI: 1548681620
Provider Name (Legal Business Name): ANDREW M WIGGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 E GALBRAITH RD # 300A
CINCINNATI OH
45236-2754
US

IV. Provider business mailing address

4700 E GALBRAITH RD # 300A
CINCINNATI OH
45236-2754
US

V. Phone/Fax

Practice location:
  • Phone: 513-347-9999
  • Fax: 513-686-4217
Mailing address:
  • Phone: 513-347-9999
  • Fax: 513-686-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50003962
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50003962RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: