Individual
JACOB WASAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14700 E OLD US HIGHWAY 12, CHELSEA, MI 48118-1185
(734) 475-1321
Mailing address
14700 E OLD US HIGHWAY 12, CHELSEA, MI 48118-1185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4351044517
MI
208D00000X
General Practice Physician
4301506490
MI
Other
Enumeration date
06/22/2019
Last updated
04/20/2022
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