Individual
DR. THOMAS RUDOLPH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-2901
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-2901
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.068981
IL
207R00000X
Internal Medicine Physician
70438-20
WI
207RG0100X
Gastroenterology Physician
Primary
70438-20
WI
Other
Enumeration date
06/04/2016
Last updated
11/20/2019
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