Individual
KYLE L WAGAMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1745 NILES CORTLAND RD NE STE 5, WARREN, OH 44484-6046
(330) 856-6365
(330) 474-3981
Mailing address
19301 CYCLONE DR, CLEVELAND, OH 44135-1731
(330) 393-4000
(330) 392-5870
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
35083746
OH
207ND0900X
Dermatopathology Physician
Primary
35083746
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217451
UNISON
OH
01
—
000000527821
ANTHEM
OH
05
—
2754827
—
OH
01
—
415051
WELLCARE
OH
01
—
7474933
AETNA
OH
01
—
748956
BUCKEYE
OH
01
—
P00406585
RAILROAD MEDICARE
OH
Enumeration date
11/20/2006
Last updated
03/27/2026
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