Healthcare Provider Details

I. General information

NPI: 1144217167
Provider Name (Legal Business Name): SARAH KATHERINE WAGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ABRAHAM FLEXNER WAY STE 300
LOUISVILLE KY
40202-3826
US

IV. Provider business mailing address

220 ABRAHAM FLEXNER WAY STE 300
LOUISVILLE KY
40202-3826
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-3376
  • Fax: 502-584-3480
Mailing address:
  • Phone: 502-584-3376
  • Fax: 502-584-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35879
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01052859A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: