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General NPI Number Information
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NPI Number | 1962426205
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Entity Type | Individual
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Provider Name | PATRICK ANTHONY WEGMAN I MD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 802 W KING ST STE H
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City | OWOSSO
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State | MI
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Zip | 48867-2100
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Country | US
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Telephone | 989-723-8281
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Fax | 989-723-6846
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Provider Business Mailing Address
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Address Line | 911 W KING ST
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City | OWOSSO
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State | MI
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Zip | 48867-2121
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Country | US
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Telephone | 989-725-2702
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301046310
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License Number State | MI
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