Wagstaff, Nathan Vincent

Wagstaff, Nathan Vincent is an individual health care provider with primary practice located at 22151 Moross Rd 313, Detroit MI 48236-2167. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Wagstaff, Nathan Vincent can be contacted via phone (313) 343-3494.

Contact Information

Primary practice address
22151 Moross Rd 313 Detroit MI 48236-2167
Phone: (313) 343-3494
Fax: (313) 343-4932
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X Michigan

Profile Details

NPI number 1669429825
LBN Legal business name Wagstaff, Nathan Vincent
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2006
Last updated Jul 19th, 2007 - about 17 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 1669429825 NPPES
Michigan Other 5315026029 CONTROLLED SUBSTANCE

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