Provider Demographics
NPI:1962426205
Name:WEGMAN, PATRICK ANTHONY I (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANTHONY
Last Name:WEGMAN
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:911 W KING ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2121
Mailing Address - Country:US
Mailing Address - Phone:989-725-2702
Mailing Address - Fax:
Practice Address - Street 1:802 W KING ST STE H
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2100
Practice Address - Country:US
Practice Address - Phone:989-723-8281
Practice Address - Fax:989-723-6846
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046310207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0700832OtherHEALTH PLUS
MI1510770Medicaid
MI070000811OtherRAILROAD MEDICARE
MI03 00389OtherPHYSICIANS HEALTH PLAN
MI07036OtherMCLAREN MEDICAID
MI0781022OtherBLUE CROSS
MI0781022OtherBLUE CROSS
MI1510770Medicaid