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Individual

CHAD MARTIN WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
333 E CAMPUS MALL RM 5131, MADISON, WI 53715-1365
(608) 265-4904
Mailing address
333 E CAMPUS MALL RM 5131, MADISON, WI 53715-1365
(608) 265-4904

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
200700438
NC
207Q00000X
Family Medicine Physician
77387-20
WI
207QS0010X
Sports Medicine (Family Medicine) Physician
064986
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
77387-20
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
128548427A
GA
05
128548427B
GA
05
128548427C
GA
05
128548427D
GA
Enumeration date
02/28/2007
Last updated
09/12/2023
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