Provider Demographics
NPI:1053310888
Name:JAGER, SUZANNE J (PA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:J
Last Name:JAGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S CEDAR ST
Mailing Address - Street 2:STE 116
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4699
Mailing Address - Country:US
Mailing Address - Phone:517-887-2511
Mailing Address - Fax:517-882-4144
Practice Address - Street 1:2660 W SUGNET RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-2898
Practice Address - Country:US
Practice Address - Phone:989-832-0900
Practice Address - Fax:989-488-5886
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002404363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS12110Medicare UPIN
MIOC36100P04Medicare ID - Type Unspecified