Individual
MICHAEL R JABARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 LEFFINGWELL AVE NE, STE 100, GRAND RAPIDS, MI 49525
(616) 459-7101
(616) 464-6170
Mailing address
1111 LEFFINGWELL AVE NE, STE 100, GRAND RAPIDS, MI 49525
(616) 459-7101
(616) 464-6170
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
4301074259
MI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
4301074259
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00243779
RR MEDICARE
—
Enumeration date
10/04/2005
Last updated
06/28/2016
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