Wagner, Robert

Wagner, Robert is an individual health care provider with primary practice located at 2160 S 1St Ave (Mcgaw Ent., Rm 47), Maywood IL 60153. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nuclear Radiology, which is considered as his primary health care specialty. Wagner, Robert can be contacted via phone (708) 216-5221.

Contact Information

Primary practice address
2160 S 1St Ave (Mcgaw Ent., Rm 47) Maywood IL 60153
Phone: (708) 216-5221
Fax: (708) 216-0899
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nuclear Radiology 2085N0904X 36071977 Illinois

Profile Details

NPI number 1154308039
LBN Legal business name Wagner, Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 30th, 2005
Last updated Apr 23rd, 2021 - about 4 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 1154308039 NPPES
Illinois MEDICAID 36071977

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