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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Jack W Wagner | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| First name | Jack | [sources] | |||
| Last name | Wagner | [sources] | |||
| Middle name | W | [sources] | |||
| NPI | 1588694004 | [sources] | |||
| Sector | Physician | [sources] | |||
| Address | Midland, MI | [sources] | |||
| Last change | Last processed | First seen | |||
Providers who have been terminated for cause from Michigan's Medicaid program.
United States of America · MDHHS
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