Wagner, Jill M

Wagner, Jill M is an individual health care provider with primary practice located at 9252 N Green Bay Rd , Brown Deer WI 53209. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Wagner, Jill M can be contacted via phone (414) 527-7500.

Contact Information

Primary practice address
9252 N Green Bay Rd Brown Deer WI 53209
Fax: (414) 365-6320
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 40255 Wisconsin

Profile Details

NPI number 1699881425
LBN Legal business name Wagner, Jill M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2006
Last updated Aug 16th, 2018 - about 8 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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Identifiers

StateTypeNumberIssuer
All States NPI 1699881425 NPPES
Wisconsin MEDICAID 34377700

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