Individual
NORMAN S. WAGGY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 W. WARREN STREET, MIDDLEBURY, IN 46540-0459
(574) 825-2146
(574) 825-2182
Mailing address
PO BOX 459, MIDDLEBURY, IN 46540-0459
(574) 825-2146
(574) 825-2182
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01030282A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080025301
R/R MEDICARE
IN
05
—
100361050A
—
IN
05
—
100361050B
—
IN
Enumeration date
07/21/2006
Last updated
03/05/2008
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