Wagener, Osvaldo

Wagener, Osvaldo is an individual health care provider with primary practice located at 1111 Superior St Suite 204, Melrose Park IL 60160-4138. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Wagener, Osvaldo can be contacted via phone (708) 223-7920.

Contact Information

Primary practice address
1111 Superior St Suite 204 Melrose Park IL 60160-4138
Phone: (708) 223-7920
Fax: (708) 338-1780
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 036086015 Illinois

Profile Details

NPI number 1770563009
LBN Legal business name Wagener, Osvaldo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 20th, 2006
Last updated Mar 10th, 2017 - about 7 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 1770563009 NPPES
Illinois MEDICAID 036086015
Illinois Other 01636011
Illinois Other 36320
Illinois Other P00291677

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