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

Michael D Wagner

Individual provider Adult Care Home Facility · NPI 1336655034

Michael D Wagner is an Adult Care Home Facility in Grand Rapids, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2017

Practice location Address checks out

807 Pine Ave NW
Grand Rapids, MI 49504-4340
Phone: (616) 776-7094
Fax: (616) 776-7094
Show map & directions

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

Specialties & licences

Adult Care Home Facility (primary) Taxonomy 311ZA0620X · Licence AF410387497 (MI)

Record details

NPI number1336655034
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 18, 2017
Last updated in NPPESDecember 18, 2017
Mailing address807 Pine Ave Nw, Grand Rapids, MI 49504-4340

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