Individual
JED GARY MAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
909 FEE RD ROOM B119, MICHIGAN STATE UNIVERSITY DEPARTMENT OF PSYCHIATRY, EAST LANSING, MI 48824-3603
(517) 353-3070
(517) 432-3603
Mailing address
965 FEE RD ROOM A239, MICHIGAN STATE UNIVERSITY DEPARTMENT OF PSYCHIATRY, EAST LANSING, MI 48824-2893
(517) 353-3070
(517) 432-3603
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
5101007621
MI
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
5101007621
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619951936
—
MI
05
—
2574234
—
MI
Enumeration date
11/30/2005
Last updated
03/12/2012
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