Individual
SAMINA M WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
718 GLENVIEW AVE, HIGHLAND PARK HOSPITAL, HIGHLAND PARK, IL 60035
(847) 480-2833
(847) 480-2675
Mailing address
718 GLENVIEW AVENUE, HIGHLAND PARK HOSPITAL, HIGHLAND PARK, IL 60035
(847) 480-2833
(847) 480-2675
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036112866
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021622158
GROUP BLUE SHIELD NUMBER
IL
05
—
036112866
—
IL
Enumeration date
03/17/2006
Last updated
07/17/2013
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