Individual
JACOB RYAN WILDHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
715 PYLE DR, KINGSFORD, MI 49802-4456
(906) 774-0522
Mailing address
715 PYLE DR, KINGSFORD, MI 49802-4456
(906) 774-0522
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205864881
—
MI
Enumeration date
12/05/2022
Last updated
12/05/2022
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