Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 04-42522 | KS |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 4301088960 | MI |
NPI | 1235117524 |
---|---|
Provider Name | Jeffrey K Wingate |
First Address | Birmingham, MI 48012-7106 |
Second Address | Rochester Hills, MI 48307-4587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F32509 | (02) |