Individual
MR. MARK B. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
468 CADIEUX RD, GROSSE POINTE, MI 48230-1507
(248) 577-3520
(248) 577-3526
Mailing address
468 CADIEUX RD, GROSSE POINTE, MI 48230-1507
(248) 577-3520
(248) 577-3526
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704254851
MI
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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