Individual
MICHAEL JOHN WANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3811 SPRING ST # 102, MOUNT PLEASANT, WI 53405-1667
(262) 687-5800
Mailing address
3811 SPRING ST # 102, MOUNT PLEASANT, WI 53405-1667
(262) 687-5800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4555
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/05/2018
Last updated
01/03/2019
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