Healthcare Provider Details

I. General information

NPI: 1053310888
Provider Name (Legal Business Name): SUZANNE J JAGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W SUGNET RD
MIDLAND MI
48670-2898
US

IV. Provider business mailing address

3500 S CEDAR ST STE 116
LANSING MI
48910-4699
US

V. Phone/Fax

Practice location:
  • Phone: 989-832-0900
  • Fax: 989-488-5886
Mailing address:
  • Phone: 517-887-2511
  • Fax: 517-882-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601002404
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: