Provider Demographics
NPI:1841221660
Name:WAGNER, JAMES W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:WAGNER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:18101 OAKWOOD BLVD
Mailing Address - Street 2:TRAUMA SERVICES DEPT
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48123-2500
Mailing Address - Country:US
Mailing Address - Phone:313-982-5440
Mailing Address - Fax:313-982-5445
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:7B WEST BLDG
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-262-9355
Practice Address - Fax:810-760-9954
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-05-24
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Provider Licenses
StateLicense IDTaxonomies
MI43010545692086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B56029OtherBLUE SHIELD OF MI
MI4511761Medicaid
MI0B56029092Medicare ID - Type Unspecified
MI4511761Medicaid