Individual
MARYCONI M JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
264 W MAPLE RD STE 200, TROY, MI 48084
(248) 273-9930
Mailing address
264 W MAPLE RD STE 200, TROY, MI 48084-5458
(248) 273-9930
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301098130
MI
207RG0100X
Gastroenterology Physician
Primary
4301098130
MI
Other
Enumeration date
07/12/2011
Last updated
07/15/2022
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