Provider Demographics
NPI:1235117524
Name:WINGATE, JEFFREY K (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:WINGATE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 BOWERS ST UNIT 2710
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7106
Mailing Address - Country:US
Mailing Address - Phone:248-228-0054
Mailing Address - Fax:248-566-3316
Practice Address - Street 1:3440 DE PAUL LN STE 113
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3546
Practice Address - Country:US
Practice Address - Phone:314-942-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128599207XS0117X
MI4301088960207XS0117X
KS04-42522207XS0117X
MO2025002087207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32509Medicare UPIN