Provider Demographics
NPI:1356479810
Name:ROSS, JONATHAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-789-0025
Mailing Address - Fax:269-789-0445
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-789-0025
Practice Address - Fax:269-789-0445
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2013-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048417207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4509502Medicaid
MI4509502Medicaid