Provider Demographics
NPI:1578011599
Name:DAVID S WILGARDE M D INC
Entity Type:Organization
Organization Name:DAVID S WILGARDE M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILGARDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-619-2309
Mailing Address - Street 1:51753 EL DORADO DR
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-9034
Mailing Address - Country:US
Mailing Address - Phone:760-619-2309
Mailing Address - Fax:866-428-0708
Practice Address - Street 1:3001 E TAHQUITZ CANYON WAY STE 108
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6900
Practice Address - Country:US
Practice Address - Phone:760-320-4292
Practice Address - Fax:760-322-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74463208100000X, 208VP0014X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty