Individual
MR. JACOB NORMAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17293 DELAWARE AVE, REDFORD, MI 48240-2302
(313) 948-7199
Mailing address
17293 DELAWARE AVE, REDFORD, MI 48240-2302
(313) 948-7199
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/25/2016
Last updated
06/25/2016
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