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General NPI Number Information
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NPI Number | 1821409343
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Entity Type | Organization
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Legal Business Name | ABRAHAM WAGNER DPM PA
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 8600 SW 92ND ST SUITE 201
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City | MIAMI
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State | FL
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Zip | 33156-7397
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Country | US
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Telephone | 305-652-6676
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Fax | 305-932-6335
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Provider Business Mailing Address
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Address Line | 21097 NE 27TH CT SUITE 200B
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City | AVENTURA
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State | FL
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Zip | 33180-1204
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Country | US
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Telephone | 305-652-6676
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Fax | 305-932-6335
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ABRAHAM WAGNER
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Credential | DPM
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Telephone | 305-652-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO3262
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License Number State | FL
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