Individual
MR. EVAN MICHAEL WAGNER I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 985-8900
Mailing address
902 BONHOMME CT, PORT HURON, MI 48060-2108
(810) 990-5311
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
10/16/2017
Last updated
03/17/2018
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