Healthcare Provider Details

I. General information

NPI: 1629908082
Provider Name (Legal Business Name): JONATHON PAUL QUINLAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GENESYS PKWY
GRAND BLANC MI
48439-8065
US

IV. Provider business mailing address

1347 BUSH CREEK DR
GRAND BLANC MI
48439-1618
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-5000
  • Fax:
Mailing address:
  • Phone: 419-574-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5151018013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: