Individual
MR. JACOB MICHAEL DAKOTA REDFOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7610 TOURNAMENT DR, WATERVILLE, OH 43566-8702
(419) 704-6634
Mailing address
471 E BROAD ST STE 1400, COLUMBUS, OH 43215-3806
(614) 228-7231
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006018RX
OH
363A00000X
Physician Assistant
5601009468
MI
Other
Enumeration date
08/22/2019
Last updated
08/16/2022
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