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1831383074
JORDAN M WAGNER
NILES, MI
NPI
1831383074
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Former Name
JORDAN M FRIZZO
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: MI 5601005116)
Enumeration Date
2007-08-30
Last Update Date
2013-03-14
Business Address
JORDAN M WAGNER PA
2002 S 11TH ST
NILES, MI 49120-4074
Phone number: 269-687-0200
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Mailing Address
JORDAN M WAGNER PA
6416 DEANS HILL RD
BERRIEN CENTER, MI 49102-9750
Phone number: 269-471-7741
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