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General NPI Number Information
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NPI Number | 1679556609
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Entity Type | Individual
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Provider Name | JOHN R WIGNESWARAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 455 TURNER RD
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City | DAYTON
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State | OH
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Zip | 45415-3630
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Country | US
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Telephone | 937-208-7930
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Fax | 937-222-7910
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Provider Business Mailing Address
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Address Line | 1 ELIZABETH PL SUITE 190
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City | DAYTON
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State | OH
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Zip | 45408-1445
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Country | US
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Telephone | 937-222-3118
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Fax | 937-222-1436
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 080805
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License Number State | OH
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