Provider Demographics
NPI:1235117524
Name:WINGATE, JEFFREY K (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:WINGATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 BOWERS ST UNIT 2710
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7106
Mailing Address - Country:US
Mailing Address - Phone:248-228-0054
Mailing Address - Fax:248-566-3316
Practice Address - Street 1:555 BARCLAY CIR STE 140
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4587
Practice Address - Country:US
Practice Address - Phone:248-566-3313
Practice Address - Fax:248-566-3316
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088960207XS0117X
KS04-42522207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32509Medicare UPIN