Healthcare Provider Details

I. General information

NPI: 1891747366
Provider Name (Legal Business Name): KRISTA M WIGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE NEOPLASTIC DISEASES
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE NEOPLASTIC DISEASES
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6800
  • Fax: 414-805-2934
Mailing address:
  • Phone: 414-805-6800
  • Fax: 414-805-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number44106
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number44106
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: