Organization
MARCUS WIGUTOW, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS WIGUTOW M.D. (PRESIDENT)
(219) 769-5900
Entity
Organization
Contact information
Practice address
9120 CONNECTICUT DR, SUITE E, MERRILLVILLE, IN 46410-7172
(219) 769-5900
(219) 769-5987
Mailing address
9120 CONNECTICUT DR., SUITE E, MERRILLVILLE, IN 46410-7172
(219) 759-5900
(219) 769-5987
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01022387B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095335
BLUE SHIELD
IN
01
—
03166600
MAGELLAN
—
05
—
1320159050
—
IL
01
—
137824
COMPSYCH
—
01
—
91106545
BLUE SHIELD
IL
Enumeration date
11/16/2007
Last updated
11/19/2007
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