Organization
K. STEVEN WAGNER, MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANNE GRAVES (OFFICE MANAGER)
(248) 652-6640
Entity
Organization
Contact information
Practice address
1500 WALTON BLVD, ROCHESTER HILLS, MI 48309-1858
(248) 652-6640
(248) 652-3914
Mailing address
1500 WALTON BLVD, ROCHESTER HILLS, MI 48309-1858
(248) 652-6640
(248) 652-3914
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
KW038400
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160009538
RR MEDICARE
—
01
—
160F353410
BCBS/BCN
—
05
—
1798911
—
MI
01
—
4264336
AETNA
—
01
—
E26269
HAP
—
Enumeration date
10/01/2008
Last updated
12/07/2020
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