Individual
MARY RUTH WILGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 203-9600
(260) 203-9602
Mailing address
10343 DAWSONS CREEK BLVD, SUITE A, FORT WAYNE, IN 46825-1906
(260) 203-9600
(260) 203-9602
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02002012
IN
208D00000X
General Practice Physician
Primary
02002012A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200196750
—
IN
Enumeration date
07/16/2006
Last updated
09/15/2016
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