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General NPI Number Information
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NPI Number | 1962560409
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Entity Type | Individual
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Provider Name | HENRY W WIGGINS M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 326 WEST 64TH STREET
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City | CHICAGO
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State | IL
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Zip | 60621
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Country | US
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Telephone | 773-962-3900
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Fax | 773-962-4399
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Provider Business Mailing Address
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Address Line | 9410 COMPUBILL DR
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City | ORLAND PARK
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State | IL
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Zip | 60462
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Country | US
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Telephone | 708-460-7444
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Fax | 708-460-8662
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036039380
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License Number State | IL
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