Sanford E Wagenberg, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

043784 Issued in MI

Practice address

11800 E Twelve Mile Road
Warren, MI 48093

Phone

(586) 573-5060

Fax

(586) 573-5197

NPI assigned

Jul 17, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 Macomb-Oakland Hospital

  • Family Medicine Physician
  • Warren, MI
  • NPI 1134176472
  NPD (past)
• Henry Ford Health St. John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088
  NPD (past)
• Michigan Orthopaedic Institute, P.C.

  • Orthopaedic Surgery Physician
  • Southfield, MI
  • NPI 1467496356
  NPD (past)
• United Eagle Imaging, LLC

  • Diagnostic Radiology Physician
  • Clarkston, MI
  • NPI 1013930460
  NPD (past)
• Macomb Magnetic Resonance Imaging Center Inc

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1235133141
  NPD (past)
• Wayne Macomb Diagnostic Imaging Center Inc

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1326042235
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1780602136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 E TWELVE MILE ROAD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48093",
            "telephone_number": "586-573-5060",
            "fax_number": "586-573-5197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 E TWELVE MILE ROAD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48093",
            "telephone_number": "586-573-5060",
            "fax_number": "586-573-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENBERG",
        "first_name": "SANFORD",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "043784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1900120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Viviano
• Zachary Hans Voelkert, PTA
• Saifuddin Tayyab Vohra, D.O.
• Ryan Volgyi
• Natalya Voronovich
• John R Wagner Jr., M.D.
• MD Wahiduzzaman, MD
• Michelle Hampton Wahula, MSW, LMSW
• Sarah Elise Waineo, MA BCBA LBA
• Jacqueline Wajer, RN

• Diagnostic Radiology Physician in Warren, MI
• Providers in Warren, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; 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.