Individual
MR. KARL GORDON WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22255 GREENFIELD RD, SUITE 422, SOUTHFIELD, MI 48075-3710
(248) 849-3195
(248) 849-3390
Mailing address
57813 CIDER MILL DR, NEW HUDSON, MI 48165-9482
(248) 486-4364
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001954
MI
Other
Enumeration date
09/27/2006
Last updated
12/30/2009
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