NPI 1003434507

Ethan J Lacourt, PAC

Practitioner Physician Assistant Grand Rapids, MI

Practice location

Address: 275 Michigan St NE, Grand Rapids, MI 49503-2531
Phone: (616) 267-7900
Fax: (616) 267-7901
Mailing address: 100 Michigan St NE # Mc845, Grand Rapids, MI 49503-2560

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 5601010844 (MI)

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Registry record

NPI: 1003434507
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Jul 2020
Record last updated: 10 Dec 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.