Individual
DR. JOHN JEFFREY ITALIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6157 28TH ST SE STE 18B, GRAND RAPIDS, MI 49546-6947
(616) 282-5969
Mailing address
6157 28TH ST SE STE 18B, GRAND RAPIDS, MI 49546-6947
(616) 282-5969
(616) 276-6089
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101027462
MI
208D00000X
General Practice Physician
5101027462
MI
Other
Enumeration date
04/26/2022
Last updated
01/02/2026
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