Karl Gordon Wagner Jr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601001954 Issued in MI

Practice address

22255 Greenfield Rd
Suite 422
Southfield, MI 48075-3710

Phone

(248) 849-3195

Fax

(248) 849-3390

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Henry Ford Health System

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1891702833
  NPD (past)
• Home Medical Services PC

  • General Practice Physician
  • Detroit, MI
  • NPI 1407039076
  NPD (past)
• Seton Health Corporation of Southeastern Michigan

  • Physical Therapy Clinic/Center
  • Macomb, MI
  • NPI 1487067260
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262131200000",
    "number": "1720179500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57813 CIDER MILL DR",
            "city": "NEW HUDSON",
            "state": "MI",
            "postal_code": "481659482",
            "telephone_number": "248-486-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD RD",
            "address_2": "SUITE 422",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753710",
            "telephone_number": "248-849-3195",
            "fax_number": "248-849-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KARL",
        "middle_name": "GORDON",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2009-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601001954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Rose Waelde, DPT
• Gunnar Waggener
• Alyssa Wagner
• Caterina Wagner
• Dejanae Tianna Wagner
• Madison Wagner
• Megan Wagner
• Jessica Anne Wahby, FNP-BC
• Annette L Wahl, NP
• Sudhir Walavalkar, MD

• Physician Assistant in Southfield, MI
• Providers in Southfield, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.