Individual
DR. DAVID DALE WAGEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1224 8TH ST, RUPERT, ID 83350-1599
(208) 436-0481
Mailing address
1640 MCMANUS DR, TROY, MI 48084-1551
(734) 673-0245
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101015277
MI
207P00000X
Emergency Medicine Physician
Primary
O-0753
ID
207R00000X
Internal Medicine Physician
5101015277
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101015277
LICENSE
MI
Enumeration date
02/07/2007
Last updated
06/06/2025
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