Individual
ARCHANA G WAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-5000
Mailing address
PO BOX 689, LAKE FOREST, IL 60045-0689
(847) 615-2200
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036100676
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
036100676
IL
208VP0014X
Interventional Pain Medicine Physician
Primary
036100676
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100676
—
IL
05
—
0546036
—
IA
Enumeration date
01/11/2006
Last updated
08/16/2023
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