Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Keith Dineen Wagner, MD

Individual provider Dermatology Physician · NPI 1760047112

Dr. Keith Dineen Wagner, MD is a Dermatology in Appleton, Wisconsin. Graduated from University of Texas Medical Branch at Galveston in 2015, 11 years ago. Practices with Forefront Dermatology SC, a 645-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
11
Trained at
University of Texas Medical Branch at Galveston
Licensed in
WI
In the registry since
2019
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3935 N Lightning Dr
Appleton, WI 54913-6717
Phone: (920) 968-1790
Fax: (920) 968-1794
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2700 Crooks Ave Ste 101, Kaukauna, WI 54130-3900 — (920) 581-5561

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 82425-20 (WI)

Record details

NPI number1760047112
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 1, 2019
Last updated in NPPESSeptember 11, 2023
Certification dateSeptember 11, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolUNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Graduated 2015 (11 years in practice)
Group practice Forefront Dermatology Sc — 645 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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