Individual
JOSHUA WIGDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
606 N MULBERRY RD, DERBY, KS 67037-3532
(316) 788-3787
Mailing address
2414 E MESITA ST, WICHITA, KS 67211-3738
(316) 200-2080
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-01821
KS
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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