Individual
MR. GORDON WILLIAM JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
202 1/2 BRIDGE ST, APT 6, GRAND LEDGE, MI 48837
(989) 745-3552
Mailing address
2775 E LANSING DR, EAST LANSING, MI 48823-7755
(517) 332-1616
(517) 332-1538
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/28/2012
Last updated
08/28/2012
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