Individual
AMY JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 284-3134
(616) 284-3135
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
4301105571
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/20/2010
Last updated
05/29/2014
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