Provider Demographics
NPI:1376691147
Name:WIGGINS, SHAWN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:M
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:TWO HURLEY PLAZA
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-262-6743
Mailing Address - Fax:810-235-1210
Practice Address - Street 1:TWO HURLEY PLAZA
Practice Address - Street 2:SUITE 204
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-262-6743
Practice Address - Fax:810-235-1210
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072235207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4455439Medicaid
MIM32030078OtherMEDICARE GROUP OM 32030
MI70-0-B5-1070-0OtherBCBSM GROUP
MI4455439Medicaid