Individual
THOMAS J. WIGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4100 PARK FOREST DR, SUITE 210, TRAVERSE CITY, MI 49684-7331
(231) 935-5770
(231) 935-0747
Mailing address
4100 PARK FOREST DR, SUITE 210, TRAVERSE CITY, MI 49684-7331
(231) 935-5770
(231) 935-0747
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704185255
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295720894
—
MI
01
—
430048952
MEDICARE RAIL ROAD TSC
MI
01
—
430B810310
BCBS TSC
MI
Enumeration date
09/20/2005
Last updated
04/15/2015
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