| Organization Name: | SHEPHERD OF HOPE CLINIC PC |
| NPI Number: | 1225014715 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS JOHN WIGTON (DIRECTOR) |
| Mailing Address: | 1028 Hannah Ave Suite D Traverse City |
| State: | MI US |
| Postal Code: | 496862963 |
| Phone Number: | 2319467360 |
| Fax Number: | 2319294775 |
| NPI Enumeration Date: | 12/16/2005 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |