Basic Information
| Provider Information | |||||||||
| NPI: | 1730849779 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JAGO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9319 HARBOR COVE CIR APT 211 | ||||||||
| Address2: | |||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481899201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157672784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30488 MILFORD RD | ||||||||
| Address2: | |||||||||
| City: | NEW HUDSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481658583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484374625 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2021 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.