Forrest, Lisa Wagner

Forrest, Lisa Wagner is an individual health care provider with primary practice located at 1850 Whites Rd , Kalamazoo MI 49008-4801. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Forrest, Lisa Wagner can be contacted via phone (269) 343-3900.

Contact Information

Primary practice address
1850 Whites Rd Kalamazoo MI 49008-4801
Phone: (269) 343-3900
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 4301057603 Michigan

Profile Details

NPI number 1821051822
LBN Legal business name Forrest, Lisa Wagner
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2006
Last updated Apr 14th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821051822 NPPES
Michigan Other 0C910950 BCBSM
Michigan MEDICAID 1821051822 BCBSM

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