| Marcus Wigutow, M.d., Inc. | |
|
9120 Connecticut Dr Suite E Merrillville IN 46410-7172 | |
| (219) 769-5900 | |
| (219) 769-5987 |
| Full Name | Marcus Wigutow, M.d., Inc. |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 9120 Connecticut Dr, Merrillville, Indiana |
| Authorized Official Name and Position | Marcus Wigutow (PRESIDENT) |
| Authorized Official Contact | 2197695900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marcus Wigutow, M.d., Inc. 9120 Connecticut Dr. Suite E Merrillville IN 46410-7172 Ph: (219) 759-5900 | Marcus Wigutow, M.d., Inc. 9120 Connecticut Dr Suite E Merrillville IN 46410-7172 Ph: (219) 769-5900 |
| NPI Number | 1790966810 |
|---|---|
| Provider Enumeration Date | 11/16/2007 |
| Last Update Date | 11/19/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790966810 | NPI | - | NPPES |
| 1320159050 | Medicaid | IL | |
| 91106545 | Other | IL | BLUE SHIELD |
| 000000095335 | Other | IN | BLUE SHIELD |
| 03166600 | Other | MAGELLAN | |
| 137824 | Other | COMPSYCH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 01022387B (Indiana) | Primary |
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