Individual
LARISA IACOBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
43361 COMMONS DR, CLINTON TOWNSHIP, MI 48038-1109
(586) 745-3006
Mailing address
43361 COMMONS DR, CLINTON TOWNSHIP, MI 48038-1109
(586) 745-3006
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011348
MI
Other
Enumeration date
10/17/2021
Last updated
12/16/2024
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