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NPI Code Detail

MEDICARE: S LATA WIGGINS MD

MEDICARE: S LATA WIGGINS MD
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
1208000000XPediatrics Physician35.044538OH

General Provider Information

NPI Number : 1346316494
Entity Type Code : Individual
Provider Name (Legal Business Name) : S LATA WIGGINS MD
Provider Business Mailing Address
First Line : 1 PERKINS SQ
Second Line :
City : AKRON
State : OH
Zip : 44308-1063
Country : US
Telephone Number : 330-478-0038
Fax Number : 330-477-1383
Provider Business Practice Location Address
First Line : 125 WHIPPLE AVE SW
Second Line :
City : CANTON
State : OH
Zip : 44710-1374
Country : US
Telephone Number : 330-478-0038
Fax Number : 330-477-1383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 03/12/2015

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Directions to “ S LATA WIGGINS MD” Practice Location

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