Individual
JACOB ICEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
280 60TH ST SE # 200, GRAND RAPIDS, MI 49548-8504
(616) 483-0750
Mailing address
280 60TH ST SE # 200, GRAND RAPIDS, MI 49548-8504
(616) 483-0750
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101026922
MI
Other
Enumeration date
06/19/2020
Last updated
07/18/2023
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