MEDICARE: JOHN R WIGNESWARAN 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
1	207RN0300X	Nephrology Physician	080805	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	310821503033	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	000000221825	OTHER	ANTHEM
3	2809872	OTHER	AETNA
4	3120003	OTHER	UHC
5	3108215037021	OTHER	UNITED MINE WORKERS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	D80805	OTHER	HUMANA

General Provider Information

NPI Number	:	1679556609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R WIGNESWARAN MD

Provider Business Mailing Address
First Line	:	1 ELIZABETH PL
Second Line	:	SUITE 190
City	:	DAYTON
State	:	OH
Zip	:	45408-1445
Country	:	US
Telephone Number	:	937-222-3118
Fax Number	:	937-222-1436

Provider Business Practice Location Address
First Line	:	455 TURNER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3630
Country	:	US
Telephone Number	:	937-208-7930
Fax Number	:	937-222-7910

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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Directions to “ JOHN R WIGNESWARAN MD” Practice Location

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