DEREK LAMONT WAGNER

DETROIT, MI
NPI1659012169
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy208D00000X General Practice
(Licence: MI  4301512090)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2022-04-06
Last Update Date2024-05-07
Business Address
Dr. DEREK LAMONT WAGNER MD
6071 W OUTER DR
DETROIT, MI 48235-2624
Phone number: 313-966-3300
Mailing Address
Dr. DEREK LAMONT WAGNER MD
1562 CRESTVIEW DR APT 306
MADISON, TN 37115-2195
Phone number: 336-407-5982