Individual
LAWRENCE WIGGINS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2361 PAYSPHERE CIR, CHICAGO, IL 60674-0023
(847) 746-4358
Mailing address
2520 ELISHA AVE, ZION, IL 60099-2676
(847) 872-4561
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/30/2006
Last updated
07/09/2007
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