Provider Demographics
NPI:1447951074
Name:WEGMAN DERMATOLOGY PLLC
Entity type:Organization
Organization Name:WEGMAN DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WEGMAN
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:989-725-6768
Mailing Address - Street 1:911 W KING ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2121
Mailing Address - Country:US
Mailing Address - Phone:989-725-2702
Mailing Address - Fax:989-720-5240
Practice Address - Street 1:802 W KING ST STE H
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2100
Practice Address - Country:US
Practice Address - Phone:989-723-8281
Practice Address - Fax:989-723-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty