MR. Jacob Norman Wagner

NPI #1194176784 in Redford, Michigan

Provider Information

NPI Number: 1194176784
Entity Type: Individual
Name: MR. Jacob Norman Wagner
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician, Other
Enumeration Date: Jun 25, 2016
Last Updated: Jun 25, 2016

Practice Location

Address: 17293 DELAWARE AVE
City: Redford
State: Michigan
ZIP Code: 48240-2302
Phone: (313) 948-7199

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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