Provider Demographics
NPI:1396710992
Name:WETZEL, JOEL A (PA)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:A
Last Name:WETZEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2118
Mailing Address - Country:US
Mailing Address - Phone:616-392-5222
Mailing Address - Fax:616-392-3653
Practice Address - Street 1:335 N 120TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2118
Practice Address - Country:US
Practice Address - Phone:616-392-5222
Practice Address - Fax:616-392-3653
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003123363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601003123OtherJAW STATE
MIJW003123OtherJAW BCBSMI
MIJW003123OtherJAW BCBSMI