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General NPI Number Information
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NPI Number | 1003892696
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Entity Type | Individual
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Provider Name | JOHN M WEGNER P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 300 E WARWICK DR
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City | ALMA
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State | MI
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Zip | 48801-1014
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Country | US
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Telephone | 989-466-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 ABBEY LN
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City | MT PLEASANT
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State | MI
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Zip | 48858-9137
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Country | US
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Telephone | 989-317-0335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601002998
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License Number State | MI
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