Wagner, Jordan M
Wagner, Jordan M is an individual health care provider with primary practice located at 2002 S 11Th St , Niles MI 49120-4074. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Wagner, Jordan M can be contacted via phone (269) 687-0200.Contact Information
Primary practice address
2002 S 11Th St
Niles MI 49120-4074
Phone: (269) 687-0200
Fax: (269) 684-0199
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 5601005116 | Michigan |
Profile Details
| NPI number | 1831383074 |
|---|---|
| LBN Legal business name | Wagner, Jordan M |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2007 |
| Last updated | Mar 14th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831383074 | NPPES |
| Michigan | MEDICAID | 1831383074 |
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