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Organization
LYNN VAN WAGNEN MD PC
Active
Organization
LYNN VAN WAGNEN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNN CLARK VAN WAGNEN MD (PHYSICIAN)
(517) 787-1990
Entity
Organization
Contact information
Practice address
1310 GREENWOOD AVE, JACKSON, MI 49203-3077
(517) 787-1990
(517) 787-9183
Mailing address
1310 GREENWOOD AVE, JACKSON, MI 49203-3077
(517) 787-1990
(517) 787-9183
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
038051
MI
Other
Enumeration date
07/01/2009
Last updated
07/27/2009
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