Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301085967 | MI |
N | 208600000X | Surgeon | 4301085967 | MI |
Y | 2086X0206X | Surgical Oncologist | 4301085967 | MI |
NPI | 1356569933 |
---|---|
Provider Name | Jessica Leigh Keto |
First Address | Grand Rapids, MI 49503 |
Second Address | Grand Rapids, MI 49503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2007 |
Last Update Date | 01/08/2011 |