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

Mr. Karl Gordon Wagner Jr., PA-C

Individual provider Physician Assistant · NPI 1720179500

Mr. Karl Gordon Wagner Jr., PA-C is a Physician Assistant in Southfield, Michigan. Licensed in Michigan. Registered with an NPI since 2006.

Licensed in
MI
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

22255 Greenfield Rd Ste 422
Southfield, MI 48075-3710
Phone: (248) 849-3195
Fax: (248) 849-3390
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601001954 (MI)

Record details

NPI number1720179500
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 27, 2006
Last updated in NPPESDecember 30, 2009

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