Individual
ANGELA B WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5926 CRAWFORDSVILLE RD UNIT B, INDIANAPOLIS, IN 46224-3722
(317) 653-2730
(317) 321-1935
Mailing address
30 W MONROE ST STE 1200, CHICAGO, IL 60603-2420
(815) 861-4302
(773) 866-8014
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
02002402A
IN
207Q00000X
Family Medicine Physician
02002402A
IN
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
02002402A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200411540
—
IN
05
—
200411540C
—
IN
Enumeration date
06/08/2006
Last updated
08/25/2020
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