Individual
EVAN MACDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1421 60TH ST SE, KENTWOOD, MI 49508-7065
(616) 610-1179
Mailing address
1111 PORT SHELDON ST, JENISON, MI 49428-9341
(616) 610-1179
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501015035
MI
Other
Enumeration date
06/01/2022
Last updated
06/01/2022
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