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General NPI Number Information
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NPI Number | 1235117524
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Entity Type | Individual
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Provider Name | JEFFREY K WINGATE MD
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Gender | Male
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 21230 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48091-2279
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Country | US
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Telephone | 248-228-0054
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 BOWERS ST UNIT 2710
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City | BIRMINGHAM
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State | MI
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Zip | 48012-7106
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Country | US
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Telephone | 248-228-0054
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Fax | 248-566-3316
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 036128599
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 04-42522
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 4301088960
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License Number State | MI
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