Individual
DENNIS L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 SOUTH DR # FH204, INDIANAPOLIS, IN 46202-5135
(317) 944-2891
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01027891A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
01027891
IN
208VP0000X
Pain Medicine Physician
Primary
01027891
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100324970
—
IN
Enumeration date
04/18/2006
Last updated
11/23/2020
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