Marcus Wigutow, M.D., Inc.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01022387B Issued in IN

Legal business name

MARCUS WIGUTOW, M.D., INC.

Practice address

9120 Connecticut Dr
Suite E
Merrillville, IN 46410-7172

Phone

(219) 769-5900

Fax

(219) 769-5987

NPI assigned

Nov 16, 2007

Last updated

Nov 19, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marcus Wigutow, M.D.

Title

President

Phone

(219) 769-5900

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1790966810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9120 CONNECTICUT DR.",
            "address_2": "SUITE E",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107172",
            "telephone_number": "219-759-5900",
            "fax_number": "219-769-5987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9120 CONNECTICUT DR",
            "address_2": "SUITE E",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107172",
            "telephone_number": "219-769-5900",
            "fax_number": "219-769-5987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARCUS WIGUTOW, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "WIGUTOW",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-769-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01022387B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "91106545",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "03166600",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1320159050",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "137824",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000000095335",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.