Provider Demographics
NPI:1033157433
Name:DIGGS, WENDELL L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:L
Last Name:DIGGS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:200 MICHIGAN AVE W
Mailing Address - Street 2:STE 103
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3632
Mailing Address - Country:US
Mailing Address - Phone:269-441-9300
Mailing Address - Fax:269-441-9330
Practice Address - Street 1:363 FREMONT ST
Practice Address - Street 2:STE 203
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3336
Practice Address - Country:US
Practice Address - Phone:269-969-6123
Practice Address - Fax:269-969-6122
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-07-27
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Provider Licenses
StateLicense IDTaxonomies
MI5601001629207Q00000X
MIWD001629363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01450006Medicare PIN
MIR64799Medicare UPIN
MI0P17180001Medicare ID - Type Unspecified