Individual
MATTHEW A WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
1500 E MEDICAL CENTER DR, B1FLOOR CANCER & GERIATRICS CENTER RECP C, ANN ARBOR, MI 48109-0916
(734) 936-6000
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4369
WI
363A00000X
Physician Assistant
50002316
OH
363A00000X
Physician Assistant
Primary
5601004953
MI
Other
Enumeration date
07/27/2006
Last updated
04/18/2025
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