Individual
JACK DANIEL DEGROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1545 68TH ST SE STE 100, GRAND RAPIDS, MI 49508-7896
(616) 267-7881
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006401
MI
Other
Enumeration date
07/27/2012
Last updated
02/14/2022
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