Individual
DR. OSVALDO WAGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 SUPERIOR ST, SUITE 204, MELROSE PARK, IL 60160-4138
(708) 223-7920
(708) 338-1780
Mailing address
1111 SUPERIOR ST, SUITE 204, MELROSE PARK, IL 60160-4138
(708) 223-7920
(708) 338-1780
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036086015
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636011
BCBS PROVIDER ID
IL
05
—
036086015
—
IL
01
—
36320
ADVOCATE HLTH CENTERS ID
IL
01
—
P00291677
RAILROAD MEDICARE
IL
Enumeration date
01/20/2006
Last updated
03/10/2017
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