Individual
MATTHEW WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CA.
Contact information
Practice address
4513 VERNON BLVD, MADISON, WI 53705-4993
(608) 698-5687
Mailing address
4513 VERNON BLVD, MADISON, WI 53705-4993
(608) 698-5687
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
761-55
WI
Other
Enumeration date
12/04/2015
Last updated
12/04/2015
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