Individual
ERMIL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 E ROLLINS RD, SUITE 103, ROUND LAKE BEACH, IL 60073-3808
(847) 740-4300
Mailing address
731 S IL ROUTE 21, STE 120, GURNEE, IL 60031-3803
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036082201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082201
—
IL
Enumeration date
10/04/2006
Last updated
01/25/2018
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