Organization
LYNN VAN WAGNEN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNN CLARK VAN WAGNEN MD (PHYSICIAN)
(517) 787-1990
Entity
Organization
Contact information
Practice address
1310 GREENWOOD AVE, JACKSON, MI 49203-3077
(517) 787-1990
(517) 787-9183
Mailing address
1310 GREENWOOD AVE, JACKSON, MI 49203-3077
(517) 787-1990
(517) 787-9183
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
038051
MI
Other
Enumeration date
07/01/2009
Last updated
07/27/2009
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