Wagner, Derek Lamont

Wagner, Derek Lamont is an sole proprietor health care provider with primary practice located at 6071 W Outer Dr , Detroit MI 48235-2624. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Wagner, Derek Lamont can be contacted via phone (313) 966-3300.

Contact Information

Primary practice address
6071 W Outer Dr Detroit MI 48235-2624
Phone: (313) 966-3300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / General Practice 208D00000X 4301512090 Michigan

Profile Details

NPI number 1659012169
LBN Legal business name Wagner, Derek Lamont
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 6th, 2022
Last updated May 7th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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