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1609440684
MITCHEL ALAN WAGNER
PEORIA, IL
NPI
1609440684
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207P00000X Emergency Medicine
(Licence: IL 036166029)
Enumeration Date
2021-05-14
Last Update Date
2023-10-03
Business Address
MITCHEL ALAN WAGNER DO
530 NE GLEN OAK AVE
PEORIA, IL 61637-0001
Phone number: 309-655-2109
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Mailing Address
MITCHEL ALAN WAGNER DO
530 NE GLEN OAK AVE
PEORIA, IL 61637-0001
Phone number: 309-655-2109
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