Wagner, Annette M

Wagner, Annette M is an individual health care provider with primary practice located at 2301 Enterprise Drive #81, Westchester IL 60154. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Dermatology, which is considered as her primary health care specialty. Wagner, Annette M can be contacted via phone (708) 836-4800.

Contact Information

Primary practice address
2301 Enterprise Drive #81 Westchester IL 60154
Phone: (708) 836-4800
Fax: (708) 836-4805
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Dermatology 207NP0225X 036089005 Illinois

Profile Details

NPI number 1477515807
LBN Legal business name Wagner, Annette M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 3rd, 2006
Last updated Sep 21st, 2011 - about 14 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 1477515807 NPPES
Illinois MEDICAID 036089005

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