Provider Demographics
NPI:1134228703
Name:WISHIK, GINGER (MD)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:WISHIK
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 534
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533-0534
Mailing Address - Country:US
Mailing Address - Phone:228-864-8454
Mailing Address - Fax:228-865-1457
Practice Address - Street 1:12266 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2759
Practice Address - Country:US
Practice Address - Phone:228-539-4141
Practice Address - Fax:228-865-9523
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS159382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119665Medicaid
MS$$$$$$$$$OtherBCBS
MS260000432Medicare PIN
MS302I261944Medicare PIN