Individual
MR. JOHN J IACOBUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
221 MICHIGAN ST NE STE 300, GRAND RAPIDS, MI 49503-2537
(616) 391-1909
(616) 391-8612
Mailing address
100 MICHIGAN ST NE # MC-845, GRAND RAPIDS, MI 49503-2560
(616) 391-1909
(616) 391-8612
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
4301047493
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3397368
—
MI
Enumeration date
10/05/2006
Last updated
06/10/2020
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