Provider Demographics
NPI:1285825489
Name:WILLIAMS, JONATHAN WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WENDELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 LINDEN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1879
Mailing Address - Country:US
Mailing Address - Phone:231-796-4470
Mailing Address - Fax:231-796-1605
Practice Address - Street 1:650 LINDEN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1879
Practice Address - Country:US
Practice Address - Phone:231-796-4470
Practice Address - Fax:231-796-1605
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301091036208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics