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Individual

MICHAEL JAGGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
611 E DOUGLAS, SUITE 309, MISHAWAKA, IN 46545-1467
(574) 252-2640
(574) 252-2650
Mailing address
PO BOX 6309, SOUTH BEND, IN 46660-6309
(574) 472-6700
(574) 472-6746

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01023464
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000269222
BCBS
IN
05
100222270A
IN
Enumeration date
06/05/2006
Last updated
12/02/2009
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