Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Marcus Wollak

Individual provider Physician Assistant · NPI 1417572827

Marcus Wollak is a Physician Assistant in South Haven, Michigan. Qualified in 2021, 5 years ago. Practices with Bronson Lakeview Hospital, a 72-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
5
Licensed in
MI
In the registry since
2020
Specialties on file
2

Practice location Address checks out

930 Blue Star Hwy
South Haven, MI 49090-7758
Phone: (269) 637-1115
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4015 Damon Ct, Eau Claire, WI 54701-3035 — (715) 225-2377

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601010639 (MI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1417572827
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 11, 2020
Last updated in NPPESOctober 27, 2021
Certification dateJune 24, 2021
Mailing address4015 Damon Ct, Eau Claire, WI 54701-3035

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Bronson Lakeview Hospital — 72 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in South Haven