Individual
DR. NIKHIL SUDHAKAR WAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4731 45TH STREET CT, ROCK ISLAND, IL 61201-7102
(309) 793-2020
(309) 793-2602
Mailing address
777 TANGLEFOOT LN, BETTENDORF, IA 52722-1650
(563) 323-2020
(563) 328-5694
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036-100181
IL
207W00000X
Ophthalmology Physician
33115
IA
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
036-100181
IL
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
33115
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060350
IA GROUP MEDICAID
IA
01
—
26568
IA GROUP MEDICARE
IA
01
—
790730
IL GROUP MEDICARE
IL
Enumeration date
12/28/2005
Last updated
03/17/2021
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