Provider Demographics
NPI:1326628744
Name:CUNHA, JONATHAN ARTHUR
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ARTHUR
Last Name:CUNHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DRIVE SPC 5332
Mailing Address - Street 2:TAUBMAN CENTER, 2ND FLOOR, RECEPTION F
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5332
Mailing Address - Country:US
Mailing Address - Phone:734-936-5738
Mailing Address - Fax:734-936-6927
Practice Address - Street 1:1500 E MEDICAL CENTER DRIVE SPC 5332
Practice Address - Street 2:TAUBMAN CENTER, 2ND FLOOR, RECEPTION F
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5332
Practice Address - Country:US
Practice Address - Phone:734-936-5738
Practice Address - Fax:734-936-6927
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351047526390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program