MEDICARE: DAVID S WILGARDE M D INC

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	208VP0014X	Interventional Pain Medicine Physician	G74463	CA
2	208100000X	Physical Medicine & Rehabilitation Physician	G74463	CA

General Provider Information

NPI Number	:	1578011599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID S WILGARDE M D INC

Provider Business Mailing Address
First Line	:	51753 EL DORADO DR
Second Line	:
City	:	LA QUINTA
State	:	CA
Zip	:	92253-9034
Country	:	US
Telephone Number	:	760-619-2309
Fax Number	:	866-428-0708

Provider Business Practice Location Address
First Line	:	3001 E TAHQUITZ CANYON WAY STE 108
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6900
Country	:	US
Telephone Number	:	760-320-4292
Fax Number	:	760-322-9475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID S WILGARDE
Credential	:	M.D.
Telephone Number	:	760-619-2309

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	06/02/2024

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