Provider Demographics
NPI:1932109519
Name:WIGGINS, MICHELE K (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:K
Last Name:WIGGINS
Suffix:
Gender:F
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:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1988
Mailing Address - Country:US
Mailing Address - Phone:281-345-3743
Mailing Address - Fax:281-517-0044
Practice Address - Street 1:8524 HIGHWAY 6 N
Practice Address - Street 2:# 339
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2103
Practice Address - Country:US
Practice Address - Phone:281-345-2743
Practice Address - Fax:281-517-0044
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6804207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113306804Medicaid
TX8C8915Medicare ID - Type Unspecified
TX113306804Medicaid