Individual
MARCUS WOLLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
930 BLUE STAR HWY, SOUTH HAVEN, MI 49090-7758
(269) 637-1115
Mailing address
4015 DAMON CT, EAU CLAIRE, WI 54701-3035
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010639
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2020
Last updated
10/27/2021
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