Provider Demographics
NPI:1821088014
Name:JAGER, KEVIN F (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:F
Last Name:JAGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:405 W GREENLAWN AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2889
Mailing Address - Country:US
Mailing Address - Phone:517-483-4780
Mailing Address - Fax:517-483-4861
Practice Address - Street 1:405 W GREENLAWN AVE STE 305
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2889
Practice Address - Country:US
Practice Address - Phone:517-483-4780
Practice Address - Fax:517-483-4861
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC37626061Medicare PIN
MI0C36100013Medicare PIN