Individual
JILL M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9252 N GREEN BAY RD, BROWN DEER, WI 53209
(414) 527-7500
(414) 365-6320
Mailing address
9252 N GREEN BAY RD, BROWN DEER, WI 53209-1104
(414) 527-7500
(414) 365-6320
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40255
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34377700
—
WI
Enumeration date
08/22/2006
Last updated
08/16/2018
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