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Individual
DR. OSVALDO WAGENER
Active
Individual
DR. OSVALDO WAGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036086015
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636011
BCBS PROVIDER ID
IL
05
—
036086015
—
IL
01
—
36320
ADVOCATE HLTH CENTERS ID
IL
01
—
P00291677
RAILROAD MEDICARE
IL
Enumeration date
01/20/2006
Last updated
03/10/2017
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