Healthcare Provider Details

I. General information

NPI: 1083290415
Provider Name (Legal Business Name): JONATHAN HY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE STE 5200
GRAND RAPIDS MI
49503-2572
US

IV. Provider business mailing address

25 MICHIGAN ST NE STE 5200
GRAND RAPIDS MI
49503-2572
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3681
  • Fax: 616-391-8670
Mailing address:
  • Phone: 616-391-8670
  • Fax: 616-391-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301517650
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301517650
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: