Individual
MICHAEL L WAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1411 N BRIARCLIFF DR, APPLETON, WI 54915-2842
(920) 730-0160
Mailing address
1411 N BRIARCLIFF DR, APPLETON, WI 54915-2842
(920) 730-0160
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25737
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31577700
—
WI
Enumeration date
09/13/2005
Last updated
06/20/2011
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