Individual
JUSTIN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
804 SERVICE RD, ROOM D100, EAST LANSING, MI 48824-7015
(517) 355-5053
Mailing address
804 SERVICE RD, ROOM D100, EAST LANSING, MI 48824-7015
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
510101797
MI
Other
Enumeration date
04/19/2012
Last updated
12/05/2025
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