Individual
MR. JACOB COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4613 W MAIN ST STE A, KALAMAZOO, MI 49006-2698
(269) 488-8672
(269) 488-8673
Mailing address
601 JOHN STREET, BOX 42, KALAMAZOO, MI 49007
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006106
MI
Other
Enumeration date
08/29/2011
Last updated
02/09/2023
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