Individual
MR. JACOB GEORGE MALOOLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2031 PEACH ST, WISCONSIN RAPIDS, WI 54494-5181
(715) 423-0122
Mailing address
2031 PEACH ST, WISCONSIN RAPIDS, WI 54494-5181
(715) 423-0122
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3306-23
WI
Other
Enumeration date
03/27/2014
Last updated
06/23/2014
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