Provider Demographics
NPI:1689863169
Name:KENNETH D WILGERS M.D. PA
Entity Type:Organization
Organization Name:KENNETH D WILGERS M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-832-8600
Mailing Address - Street 1:3129 COLLEGE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4660
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH11697146M00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH11697Medicare UPIN