Active NPI
Jodi Iacco
- Surgical Physician Assistant
- Detroit, MI
National Provider Identifier
1801162532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 5601006048
- Practice address
- 22201 Moross Rd
Professional Building 1 Suite 132
Detroit, MI 48236-2169 - Phone
- (313) 343-3360
- NPI assigned
- Mar 27, 2012
- Last updated
- Mar 27, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 5601006048 | MI | Primary |
Addresses
Primary practice location
22201 Moross Rd
Professional Building 1 Suite 132
Detroit, MI 48236-2169
Mailing address
22201 Moross Rd
Professional Building 1 Suite 132
Detroit, MI 48236-2169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332806400000",
"number": "1801162532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22201 MOROSS RD",
"address_2": "PROFESSIONAL BUILDING 1 SUITE 132",
"city": "DETROIT",
"state": "MI",
"postal_code": "482362169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22201 MOROSS RD",
"address_2": "PROFESSIONAL BUILDING 1 SUITE 132",
"city": "DETROIT",
"state": "MI",
"postal_code": "482362169",
"telephone_number": "313-343-3360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IACCO",
"first_name": "JODI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-27",
"last_updated": "2012-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MI",
"license": "5601006048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.