Provider Demographics
NPI:1750449740
Name:WAGSHUL, ALAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MICHAEL
Last Name:WAGSHUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 S.W. 67TH COURT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-661-4580
Mailing Address - Fax:305-661-4580
Practice Address - Street 1:8810 SW 67TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-1700
Practice Address - Country:US
Practice Address - Phone:305-661-4580
Practice Address - Fax:305-661-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 138452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology