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NPI Code Detail

MEDICARE: DR. JAY FOSTER WIGBOLDY MD

MEDICARE: DR. JAY FOSTER WIGBOLDY 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
12085R0202XDiagnostic Radiology Physician01079663AIN
22085R0202XDiagnostic Radiology Physician34489KY
32085R0202XDiagnostic Radiology Physician036144663IL

Other Identifiers

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

General Provider Information

NPI Number : 1487636569
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAY FOSTER WIGBOLDY MD
Provider Business Mailing Address
First Line : 5901 TECHNOLOGY CENTER DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-6013
Country : US
Telephone Number : 317-972-9669
Fax Number : 317-715-9990
Provider Business Practice Location Address
First Line : 5901 TECHNOLOGY CENTER DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-6013
Country : US
Telephone Number : 317-972-9669
Fax Number : 317-715-9990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 01/22/2026

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