Ebrom, John Stephen
Ebrom, John Stephen is an individual health care provider with primary practice located at 200 Jefferson Ave Se , Grand Rapids MI 49503. He recently has only one registered license in Allopathic & Osteopathic Physicians / Clinical Pathology/Laboratory Medicine, which is considered as his primary health care specialty. Ebrom, John Stephen can be contacted via phone (616) 364-6700.Contact Information
Primary practice address
200 Jefferson Ave Se
Grand Rapids MI 49503
Phone: (616) 364-6700
Fax: (616) 364-4960
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Clinical Pathology/Laboratory Medicine | 207ZP0105X | 4301044412 | Michigan |
Profile Details
| NPI number | 1184636953 |
|---|---|
| LBN Legal business name | Ebrom, John Stephen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 12th, 2006 |
| Last updated | Aug 20th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184636953 | NPPES |
| Michigan | MEDICAID | 4525177100 | |
| Michigan | Other | P00009267 |
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