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NPI Code Detail

MEDICARE: JONATHAN PATRICK WINDELER MD

MEDICARE: JONATHAN PATRICK WINDELER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician43101070121MI
2208000000XPediatrics Physician43101070121MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306890850
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN PATRICK WINDELER MD
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC 845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-754-4691
Fax Number : 616-754-3828
Provider Business Practice Location Address
First Line : 615 S BOWER ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2614
Country : US
Telephone Number : 616-754-4691
Fax Number : 616-754-3828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 07/22/2021

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