Wagner, Frederick
Wagner, Frederick is an individual health care provider with primary practice located at 5921 Meridian Woods Drive , Glen Carbon IL 62034-1545. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Wagner, Frederick can be contacted via phone (618) 391-5883.Contact Information
Primary practice address
5921 Meridian Woods Drive
Glen Carbon IL 62034-1545
Phone: (618) 391-5883
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 113352 | Missouri |
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 036124604 | Illinois |
Profile Details
| NPI number | 1770589053 |
|---|---|
| LBN Legal business name | Wagner, Frederick |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 22nd, 2005 |
| Last updated | Apr 14th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770589053 | NPPES |
| Illinois | MEDICAID | 1770589053 | |
| Illinois | MEDICAID | 205374309 |
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