Healthcare Provider Details

I. General information

NPI: 1639667231
Provider Name (Legal Business Name): SAGAR WAGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PINE RIDGE BLVD
WAUSAU WI
54401-4120
US

IV. Provider business mailing address

333 PINE RIDGE BLVD
WAUSAU WI
54401-4120
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2283
  • Fax:
Mailing address:
  • Phone: 715-847-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301512072
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number83977-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01096814A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA184916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: