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General NPI Number Information
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NPI Number | 1417108051
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Entity Type | Organization
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Legal Business Name | K. STEVEN WAGNER, MD PLLC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 1500 WALTON BLVD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1858
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Country | US
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Telephone | 248-652-6640
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Fax | 248-652-3914
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Provider Business Mailing Address
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Address Line | 1500 WALTON BLVD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1858
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Country | US
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Telephone | 248-652-6640
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Fax | 248-652-3914
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JEANNE GRAVES
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Credential |
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Telephone | 248-652-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | KW038400
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License Number State | MI
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