Individual
ANNETTE M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2301 ENTERPRISE DRIVE, #81, WESTCHESTER, IL 60154
(708) 836-4800
(708) 836-4805
Mailing address
2300 CHILDREN'S PLAZA, #107, CHICAGO, IL 60614
(312) 227-6060
(312) 227-9402
Taxonomy
Speciality
Code
Description
License number
State
207NP0225X
Pediatric Dermatology Physician
Primary
036089005
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089005
—
IL
Enumeration date
04/03/2006
Last updated
09/21/2011
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