Individual
DR. MICHAEL W. WINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1304
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1304
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036-082833
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060016817
RAILROAD MEDICARE
IL
05
—
1568471118 1
—
IL
01
—
279500
MEDICARE GROUP
IL
Enumeration date
08/05/2006
Last updated
10/02/2008
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