MEDICARE: MR. JOEL A WETZEL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601003123	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5601003123	OTHER	MI	JAW STATE
2	JW003123	OTHER	MI	JAW BCBSMI

General Provider Information

NPI Number	:	1396710992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL A WETZEL PA

Provider Business Mailing Address
First Line	:	335 N 120TH AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-2118
Country	:	US
Telephone Number	:	616-392-5222
Fax Number	:	616-392-3653

Provider Business Practice Location Address
First Line	:	335 N 120TH AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-2118
Country	:	US
Telephone Number	:	616-392-5222
Fax Number	:	616-392-3653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	08/28/2012

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Directions to “ MR. JOEL A WETZEL PA” Practice Location

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