Individual
DR. JACOB MICHAEL KAYLE LISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
230 S FRONTAGE RD, NEW HAVEN, CT 06519-1124
(203) 737-7129
Mailing address
230 S FRONTAGE RD, NEW HAVEN, CT 06519-1124
(203) 737-7129
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/14/2022
Last updated
04/14/2022
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