| Dr Matthew Steven Wagner, MD | |
| 420 E 1st St, Duluth, MN 55805-1901 | |
| (218) 786-8364 | |
| Not Available | 
| Full Name | Dr Matthew Steven Wagner | 
|---|---|
| Gender | Male | 
| Speciality | Radiology - Diagnostic Radiology | 
| Location | 420 E 1st St, Duluth, Minnesota | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1164918199 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 74110 (Minnesota) | Primary | 
| 207R00000X | Internal Medicine | RL15231 (North Dakota) | Secondary | 
| Entity Name | The Duluth Clinic Ltd | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1902563638 PECOS PAC ID: 2567374283 Enrollment ID: O20031103000229 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Dr Matthew Steven Wagner, MD 400 E 3rd St, Duluth, MN 55805-1951 Ph: (218) 786-8364 | Dr Matthew Steven Wagner, MD 420 E 1st St, Duluth, MN 55805-1901 Ph: (218) 786-8364 | 
| Bruce James Derauf,  Radiology Medicare: Accepting Medicare Assignments Practice Location: 400 E 3rd St, Duluth, MN 55805 Phone: 218-786-8364 | |
| Mrs. Rebecca Lynn Kuntz, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 925 E Superior St, Suite 109, Duluth, MN 55802 Phone: 218-722-3700 Fax: 218-722-8705 | |
| Kenneth Dornfeld, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 400 East 3rd Street, Duluth, MN 55805 Phone: 218-786-8364 | |
| Dr. William E. Johnson, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 925 E Superior St, Suite109, Duluth, MN 55802 Phone: 218-722-3700 Fax: 218-722-8705 | |
| Dr. Ryan Patrick Wippler, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 420 E 1st St, Duluth, MN 55805 Phone: 218-786-8364 | |
| Michael Edward Ryan,  Radiology Medicare: Accepting Medicare Assignments Practice Location: 400 E 3rd St, Duluth, MN 55805 Phone: 218-786-8364 |