Provider Demographics
NPI:1275506206
Name:WILGERS, KENNETH D (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:WILGERS
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 1:3129 COLLEGE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4682
Mailing Address - Country:US
Mailing Address - Phone:409-832-8600
Mailing Address - Fax:409-832-8601
Practice Address - Street 1:3129 COLLEGE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4660
Practice Address - Country:US
Practice Address - Phone:409-832-8600
Practice Address - Fax:409-832-8601
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7946207Q00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B1982Medicare ID - Type Unspecified
TX8F6164Medicare PIN
TXH11697Medicare UPIN