Individual
NATHAN VINCENT WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22151 MOROSS RD, 313, DETROIT, MI 48236-2167
(313) 343-3494
(313) 343-4932
Mailing address
43800 GARFIELD RD, CLINTON TWP, MI 48038-1136
(800) 848-0202
(586) 226-6949
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315026029
CONTROLLED SUBSTANCE
MI
Enumeration date
05/30/2006
Last updated
07/19/2007
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