Individual
DR. RICHARD F WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
252 MCHENRY ST, BURLINGTON, WI 53105-1828
(262) 767-6100
Mailing address
4220 WILDERNESS DR, MOUNT PLEASANT, WI 53403-4416
(262) 554-0328
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
20111
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30773500
—
WI
Enumeration date
04/08/2006
Last updated
04/05/2016
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