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1043836612
JACOB ICEBERG
GRAND RAPIDS, MI
NPI
1043836612
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: MI 5101026922)
Enumeration Date
2020-06-19
Last Update Date
2023-07-18
Business Address
JACOB ICEBERG DO
280 60TH ST SE # 200
GRAND RAPIDS, MI 49548-8504
Phone number: 616-483-0750
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Mailing Address
JACOB ICEBERG DO
280 60TH ST SE # 200
GRAND RAPIDS, MI 49548-8504
Phone number: 616-483-0750
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