MEDICARE: DOUGLAS WIGTON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	5101007426	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184600116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS WIGTON DO

Provider Business Mailing Address
First Line	:	3271 RACQUET CLUB DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4708
Country	:	US
Telephone Number	:	231-735-8006
Fax Number	:	231-735-8023

Provider Business Practice Location Address
First Line	:	3271 RACQUET CLUB DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4708
Country	:	US
Telephone Number	:	231-735-8006
Fax Number	:	231-735-8023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	09/30/2020

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Directions to “ DOUGLAS WIGTON DO” Practice Location

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