Provider Demographics
NPI:1396842183
Name:LODWICK, JAY (PA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:LODWICK
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:4350 JACKSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1889
Practice Address - Country:US
Practice Address - Phone:734-761-2581
Practice Address - Fax:734-761-9540
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-12-14
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Provider Licenses
StateLicense IDTaxonomies
MI5601003391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant