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1720179500
KARL GORDON WAGNER
SOUTHFIELD, MI
NPI
1720179500
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: MI 5601001954)
Enumeration Date
2006-09-27
Last Update Date
2009-12-30
Business Address
Mr. KARL GORDON WAGNER PA-C
22255 GREENFIELD RD SUITE 422
SOUTHFIELD, MI 48075-3710
Phone number: 248-849-3195
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Mailing Address
Mr. KARL GORDON WAGNER PA-C
57813 CIDER MILL DR
NEW HUDSON, MI 48165-9482
Phone number: 248-486-4364
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