Provider Demographics
NPI:1184913097
Name:WIGLEY, STEPHEN IV (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:WIGLEY
Suffix:IV
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4717
Mailing Address - Country:US
Mailing Address - Phone:305-895-9528
Mailing Address - Fax:786-332-3242
Practice Address - Street 1:1595 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4717
Practice Address - Country:US
Practice Address - Phone:305-895-9528
Practice Address - Fax:786-332-3242
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3625213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010794200Medicaid