Individual
JACOB MICHAEL GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 695-8200
(616) 940-5362
Mailing address
1101 FULLER AVE SE, GRAND RAPIDS, MI 49506-3246
(616) 965-8200
(616) 940-5362
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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