ETHAN JORDAN LACOURT

GRAND RAPIDS, MI
NPI1003434507
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: MI  5601010844)
Enumeration Date2020-07-10
Last Update Date2022-01-10
Business Address
Mr. ETHAN JORDAN LACOURT PA-C
100 MICHIGAN ST NE
GRAND RAPIDS, MI 49503-2560
Phone number: 616-391-3139
Mailing Address
Mr. ETHAN JORDAN LACOURT PA-C
100 MICHIGAN ST NE # MC845
GRAND RAPIDS, MI 49503-2560
Phone number:
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