Individual
JACOB ALEX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22250 PROVIDENCE DR STE 301, SOUTHFIELD, MI 48075-6211
(248) 849-4818
Mailing address
22250 PROVIDENCE DR STE 301, SOUTHFIELD, MI 48075-6211
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/16/2019
Last updated
07/16/2019
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