Provider Demographics
NPI:1114055829
Name:DWIGHT W WOOD MD PLC
Entity Type:Organization
Organization Name:DWIGHT W WOOD MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-845-7373
Mailing Address - Street 1:7 N ATKINSON DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1953
Mailing Address - Country:US
Mailing Address - Phone:231-845-7373
Mailing Address - Fax:231-845-7374
Practice Address - Street 1:7 N ATKINSON DR
Practice Address - Street 2:SUITE 115
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1953
Practice Address - Country:US
Practice Address - Phone:231-845-7373
Practice Address - Fax:231-845-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071620207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI17971OtherPRIORITY HEALTH
MI3469260Medicaid
MI1805300251OtherBCBS
0N95200Medicare PIN
MI3469260Medicaid