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Individual

JOHN M WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
251 E HURON STREET, CHICAGO, IL 60611
(312) 926-2000
Mailing address
251 E HURON STREET, CHICAGO, IL 60611

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.075694
IL
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
036164499
IL

Other

Enumeration date
05/28/2020
Last updated
01/09/2025
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