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

Mitchel Alan Wagner, DO

Individual provider Emergency Medicine Physician · NPI 1609440684

Mitchel Alan Wagner, DO is an Emergency Medicine in Peoria, Illinois. Graduated from Pacific NW Un of Hs, Col of Osteopathic Medicine in 2021, 5 years ago. Practices with Prosser Public Hospital District of Benton County, a 111-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
5
Trained at
Pacific NW Un of Hs, Col of Osteopathic Medicine
Licensed in
IL
In the registry since
2021
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone: (309) 655-2109
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 036166029 (IL)

Record details

NPI number1609440684
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMay 14, 2021
Last updated in NPPESOctober 3, 2023
Certification dateOctober 3, 2023
Mailing address530 Ne Glen Oak Ave, Peoria, IL 61637-0001

Medicare enrollment

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

Medicare specialtyEMERGENCY MEDICINE
Medical schoolPACIFIC NW UN OF HS, COL OF OSTEOPATHIC MEDICINE
Graduated 2021 (5 years in practice)
Group practice Prosser Public Hospital District Of Benton County — 111 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Peoria