| Doctor Name: | DOUGLAS WIGTON |
| NPI Number: | 1184600116 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 5101007426 |
| Business Practice Address: | 1028 Hannah Ave Ste D Traverse City, MI - 496862963 |
| Business Phone Number: | 2319467360 |
| Business Fax Number: | 2319294775 |
| Mailing Address: | 1028 Hannah Ave, Ste D TRAVERSE CITY |
| State: | MI |
| Postal Code: | 496862963 |
| Phone Number: | 2319467360 |
| Fax Number: | 2319294775 |
| NPI Enumeration Date: | 12/21/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101007426 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |