Individual
JACOB BENNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
601 JOHN ST, KALAMAZOO, MI 49007-5341
(269) 341-6386
Mailing address
950 TRADE CENTRE WAY STE 230, PORTAGE, MI 49002-0492
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101027955
MI
390200000X
Student in an Organized Health Care Education/Training Program
5101027955
MI
390200000X
Student in an Organized Health Care Education/Training Program
5151015760
MI
Other
Enumeration date
05/31/2022
Last updated
07/28/2025
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