Individual
LYNN CLARK VANWAGNEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1310 GREENWOOD AVE, JACKSON, MI 49203-3077
(517) 787-1990
Mailing address
1310 GREENWOOD AVE, JACKSON, MI 49203-3077
(517) 787-1990
(517) 787-1983
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301038051
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101587882
—
MI
01
—
110241201
RR MEDICARE
MI
Enumeration date
04/27/2006
Last updated
10/10/2011
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