Brian Wagenaar, MD | |
820 S Damen Ave, Chicago, IL 60612-3728 | |
(312) 569-8387 | |
Not Available |
Full Name | Brian Wagenaar |
---|---|
Gender | Male |
Speciality | Internal Medicine |
Location | 820 S Damen Ave, Chicago, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1669714234 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208M00000X | Hospitalist | 036141019 (Illinois) | Secondary |
207R00000X | Internal Medicine | 036141019 (Illinois) | Primary |
Entity Name | Rush University Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1093819542 PECOS PAC ID: 5496658874 Enrollment ID: O20040202000228 |
Mailing Address | Practice Location Address |
---|---|
Brian Wagenaar, MD 820 S Damen Ave, Chicago, IL 60612-3728 Ph: (312) 569-8387 | Brian Wagenaar, MD 820 S Damen Ave, Chicago, IL 60612-3728 Ph: (312) 569-8387 |
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