Provider Demographics
NPI:1881048213
Name:BLAIS, JONATHON MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:MICHAEL
Last Name:BLAIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18854 GREENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1169
Mailing Address - Country:US
Mailing Address - Phone:616-502-2070
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE 100
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5317
Practice Address - Country:US
Practice Address - Phone:269-373-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022196207R00000X
MI5101026876207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine