John Stephen Ebrom, MD
Pathology, Clinical Pathology/Laboratory Medicine in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1184636953
StatusActive
Last updated in NPPESAug 20, 2007
Details
- NPI
- 1184636953
- Entity type
- Individual (NPI-1)
- Name
- John Stephen Ebrom
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 12, 2006
- Last updated
- Aug 20, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207ZP0105X | Pathology, Clinical Pathology/Laboratory Medicine | 4301044412 | MI | Yes |
Practice location
200 Jefferson Ave SeGrand Rapids, MI 49503
Phone 616-364-6700 · Fax 616-364-4960
Mailing address
Po Box 77000Dept #77339
Detroit, MI 48277-0339
Phone 616-364-6700 · Fax 616-364-4960
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