Individual
JACOB ENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 S PARK ST STE A, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-2961
Mailing address
700 S PARK ST STE A, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-2961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7375
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104550276
—
WI
Enumeration date
07/13/2022
Last updated
09/06/2023
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