DR. JUSTIN TIMOTHY WAGNER (NPI# 1356608004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356608004 |
| Entity Type | Individual |
| Full Name | DR. JUSTIN TIMOTHY WAGNER |
| Credential | D.O. |
| Practice Address |
804 Service Rd Room D100 East Lansing MI 48824-7021 |
| Practice Telephone | 5173555053 |
| Practice Fax Number | 5174324394 |
| Mailing Telephone | 5173555053 |
| Mailing Fax Number | 5174324394 |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2013-05-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
510101797 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1356608004 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871818484 | Justin Philip Wagner | Surgery | 200 Ucla Medical Plz # 265, Los Angeles, CA 90095-8344 | 2010-04-07 |
| 1669451472 | Justin Roman Wagner | Specialist | Rec Center Physical Therapy, 400 Collins Rd Ne 154-100, Cedar Rapids, IA 52498-0001 | 2006-01-10 |
| 1871121798 | Justin John Wagner | Student in an Organized Health Care Education/Training Program | 2601 Ocean Pkwy, Brooklyn, NY 11235-7745 | 2020-03-27 |
| 1245647700 | Justin Wagner | Pharmacist | 1650 W Maloney Ave, Gallup, NM 87301-3305 | 2014-07-16 |
| 1306051362 | Justin B Wagner | Emergency Medicine | 1650 Creekside Dr, Folsom, CA 95630-3400 | 2007-05-13 |
| Street Address |
804 SERVICE RD ROOM D100 |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-7021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457355042 | Elizabeth Hengstebeck | Family Medicine | 804 Service Rd, A142, East Lansing, MI 48824-7015 | 2005-06-10 |
| 1467906271 | Barbara Mitchell | Nurse Practitioner | 804 Service Rd, A217, East Lansing, MI 48824-7015 | 2016-08-09 |
| 1578946406 | Prajwal Dhakal | Internal Medicine | 804 Service Rd, A225, East Lansing, MI 48824-7015 | 2015-07-09 |
| 1184007890 | Omar Albanyan | Internal Medicine | 804 Service Rd, A225 Clinical Center, East Lansing, MI 48824-7015 | 2015-06-30 |
| 1942681226 | Laura Bohatch | Internal Medicine | 804 Service Rd, A-225 Clinical Center, East Lansing, MI 48824-7015 | 2015-06-12 |
| 1225417850 | Georgette Cooke | Internal Medicine | 804 Service Rd, A-225 Clinical Center, East Lansing, MI 48824-7015 | 2015-05-28 |
| 1326427931 | Negar Salehi | Internal Medicine | 804 Service Rd, A-225 Clinical Center, East Lansing, MI 48824 | 2015-05-28 |
| 1871900563 | Tariq Khalid Alrasheed | Internal Medicine | 804 Service Rd, Room A-225, East Lansing, MI 48824-7021 | 2014-07-15 |
| 1851716732 | Christie Daiss | Pharmacist | 804 Service Rd, A-101, East Lansing, MI 48824-7021 | 2014-02-28 |
| 1538583380 | Jane French | Pharmacist | 804 Service Rd, East Lansing, MI 48824-7021 | 2014-02-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134483985 | Robert Jarrett Steffy | Radiology | 846 Service Rd, East Lansing, MI 48824-7017 | 2012-06-26 |
| 1386809036 | Charles Tribue Hounshell | Radiology | 4660 S Hagadorn Rd Ste 410, East Lansing, MI 48823-6819 | 2008-07-22 |
| 1053587535 | Thomas Loi | Radiology | 138 Service Rd Ste A204, East Lansing, MI 48824-1376 | 2008-05-05 |
| 1902007644 | Daniel Glen Vickers | Radiology | 138 Service Rd Ste D100, East Lansing, MI 48824-1313 | 2007-05-30 |
| 1417162819 | Andrew Guglielmi | Radiology | D100 Clinical Ctr, East Lansing, MI 48824-1313 | 2007-05-11 |
| 1932286945 | Ryan Stephen Fajardo | Radiology | 804 Service Rd Ste D100, East Lansing, MI 48824-7015 | 2006-11-01 |
| 1437246071 | Edward James Potchen | Radiology | 184 Radiology Building, East Lansing, MI 48824 | 2006-10-06 |
| 1679526867 | Bing Tai | Radiology | 627 Whitehills Dr, East Lansing, MI 48823-2731 | 2006-05-18 |
| 1275945768 | Julia Hobson | Radiology | 4660 S Hagadorn Rd Ste 410, East Lansing, MI 48823-6819 | 2014-06-02 |
| 1285074914 | Ezemonye O Madu | Radiology | 4660 S Hagadorn Rd Ste 600, East Lansing, MI 48823-5383 | 2013-06-26 |
| Find all providers in EAST LANSING | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
Please comment or provide details below to improve the information on DR. JUSTIN TIMOTHY WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.