Individual
ALEX FRANCIS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6401 PRAIRIE ST, SUITE 1600, NORTON SHORES, MI 49444-7840
(231) 727-7920
(231) 727-7921
Mailing address
600 BROADWAY AVE NW APT 425, GRAND RAPIDS, MI 49504-7324
(989) 387-5540
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101020032
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N28430113
MEDICARE IND PTAN
MI
Enumeration date
06/19/2012
Last updated
01/05/2016
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