Organization
ARCHANA WAGLE M D A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARCHANA WAGLE MD (OWNER)
(847) 615-2200
Entity
Organization
Contact information
Practice address
500 JOHN DEERE RD, MOLINE, IL 61265-6892
(309) 779-5000
Mailing address
925 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
(847) 615-2200
(847) 615-2858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036100676
IL
208VP0014X
Interventional Pain Medicine Physician
Primary
036100676
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100676
—
IL
Enumeration date
04/02/2010
Last updated
07/15/2010
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