Individual
MICHAEL D WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
807 PINE AVE NW, GRAND RAPIDS, MI 49504-4340
(616) 776-7094
(616) 776-7094
Mailing address
807 PINE AVE NW, GRAND RAPIDS, MI 49504-4340
(616) 776-7094
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AF410387497
MI
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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