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

Jack Wagoner, MD

Individual provider Surgery Physician · NPI 1518979665

Jack Wagoner, MD is a General Surgery in Sycamore, Illinois. Graduated from Southern Illinois University School of Medicine in 1993, 33 years ago. Practices with Central Dupage Physician Group, a 1,094-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
33
Trained at
Southern Illinois University School of Medicine
Licensed in
IL
In the registry since
2006
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

1850 Gateway Dr
Sycamore, IL 60178-3192
Phone: (815) 758-8671
Fax: (815) 758-5610
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 036-100314 (IL)

Record details

NPI number1518979665
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 13, 2006
Last updated in NPPESJune 11, 2012
Mailing address1850 Gateway Dr, Sycamore, IL 60178-3192

Medicare enrollment

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

Medicare specialtyGENERAL SURGERY
Medical schoolSOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 1993 (33 years in practice)
Group practice Central Dupage Physician Group — 1094 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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