Basic Information
| Provider Information | |||||||||
| NPI: | 1881009413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSMAN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 LAKESHORE DR | ||||||||
| Address2: | |||||||||
| City: | ISHPEMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498491367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064852687 | ||||||||
| FaxNumber: | 9064852753 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 W CENTRAL AVE | ||||||||
| Address2: | #200 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912051 | ||||||||
| FaxNumber: | 4194796952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 07/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301111886 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.