Provider Demographics
NPI:1033143052
Name:JEFFREY K. WINGATE, M.D.
Entity Type:Organization
Organization Name:JEFFREY K. WINGATE, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-755-9800
Mailing Address - Street 1:13355 EAST TEN MILE ROAD
Mailing Address - Street 2:MEDICAL OFFICE BUILDING EAST STE. 115
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089
Mailing Address - Country:US
Mailing Address - Phone:586-755-9800
Mailing Address - Fax:586-755-9870
Practice Address - Street 1:13355 EAST TEN MILE ROAD
Practice Address - Street 2:MEDICAL OFFICE BUILDING EAST STE. 115
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-755-9800
Practice Address - Fax:586-755-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15519207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3248Medicaid
SC7962Medicare ID - Type UnspecifiedPROVIDER NUMBER
SCF32509Medicare UPIN