Provider Demographics
NPI:1316933492
Name:KIGGUNDU, EDWARD W (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:KIGGUNDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:304-262-8800
Practice Address - Fax:304-262-8203
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVD00592452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7960384OtherAETNA PROVIDER NUMBER
MD61647309OtherCARE FIRST BCBS PROV. #
WV5990540OtherCIGNA PROVIDER NUMBER
VI01050264Medicaid
WV5129591OtherMAMSI PROVIDER NUMBER
DE1000034742Medicaid
WV3810004107Medicaid
H70217Medicare UPIN
WV7960384OtherAETNA PROVIDER NUMBER