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NPI Code Detail

MEDICARE: JOHN D WAGEL MD

MEDICARE: JOHN D WAGEL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician01040117AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00266379OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30000372545OTHERINBC/BS

General Provider Information

NPI Number : 1487630414
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN D WAGEL MD
Provider Business Mailing Address
First Line : # 774560, 4560 SOLUTIONS CENTER
Second Line :
City : CHICAGO
State : IL
Zip : 60677-4005
Country : US
Telephone Number : 260-969-1950
Fax Number : 260-918-2137
Provider Business Practice Location Address
First Line : 1316 E 7TH ST
Second Line :
City : AUBURN
State : IN
Zip : 46706-2523
Country : US
Telephone Number : 260-925-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 02/29/2012

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Directions to “ JOHN D WAGEL MD” Practice Location

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