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Individual

JODI IACCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
22201 MOROSS RD, PROFESSIONAL BUILDING 1 SUITE 132, DETROIT, MI 48236-2169
(313) 343-3360
Mailing address
22201 MOROSS RD, PROFESSIONAL BUILDING 1 SUITE 132, DETROIT, MI 48236-2169

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601006048
MI

Other

Enumeration date
03/27/2012
Last updated
03/27/2012
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