Provider Demographics
NPI:1356922231
Name:JAGGER, ABIGALE FAITH (DO)
Entity type:Individual
Prefix:
First Name:ABIGALE
Middle Name:FAITH
Last Name:JAGGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 HEIMBERGER RD NW
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9405
Mailing Address - Country:US
Mailing Address - Phone:614-306-8807
Mailing Address - Fax:
Practice Address - Street 1:DETROIT MEDICAL CENTER, GME OFFICE, 4201 ST. ANTOINE
Practice Address - Street 2:UHC-9C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-4820
Practice Address - Country:US
Practice Address - Phone:313-745-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program