Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01052501A | IN |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 36924 | KY |
NPI | 1063470649 |
---|---|
Provider Name | Dr. Lee S Wagmeister |
First Address | Newburgh, IN 47630-8925 |
Second Address | Newburgh, IN 47630-8925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 17/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000174053 | ANTHEM (01) | |
0000475621-01 | WELBORN HEALTH PLANS (01) | |
200267590 | (05) | IN |
330005278 | IN RR MCR (01) | |
438544 | HEALTHLINK (01) | |
64024532 | (05) | KY |
832011P | SIHO (01) | |
H16900 | (02) |