Individual
DR. KARL THOMAS WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1824 DORCHESTER CT, SUITE A, GOSHEN, IN 46526-6819
(574) 534-2548
(574) 534-3622
Mailing address
1824 DORCHESTER CT, SUITE A, GOSHEN, IN 46526-6819
(574) 534-2548
(574) 534-3622
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01062265A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000491386
ANTHEM
IN
05
—
200826680
—
IN
Enumeration date
08/09/2005
Last updated
09/08/2011
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