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Individual

JAY PATRICK LABINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
245 CHERRY ST SE, SUITE 102, GRAND RAPIDS, MI 49503-4607
(616) 456-5311
(616) 456-7955
Mailing address
245 CHERRY ST SE STE 102, GRAND RAPIDS, MI 49503-4607
(616) 456-5311
(616) 456-7955

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301058128
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0D16117
BCBS
MI
05
3352544
MI
Enumeration date
11/10/2005
Last updated
03/09/2009
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