Individual
DR. MICHEL RANDOLPH PETER WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2580 HAYMAKER RD STE 304, MONROEVILLE, PA 15146-3500
(412) 858-3070
(412) 858-3076
Mailing address
2580 HAYMAKER RD STE 304, MONROEVILLE, PA 15146-3500
(412) 858-3070
(412) 858-3076
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD066014L
PA
2086S0102X
Surgical Critical Care Physician
Primary
MD066014L
PA
2086S0127X
Trauma Surgery Physician
MD066014L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10614208
CAQH
—
Enumeration date
05/11/2006
Last updated
10/06/2020
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