Healthcare Provider Details

I. General information

NPI: 1992325492
Provider Name (Legal Business Name): JONATHAN SHARLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 HOLT RD
HOLT MI
48842-1673
US

IV. Provider business mailing address

4410 HOLT RD
HOLT MI
48842-1673
US

V. Phone/Fax

Practice location:
  • Phone: 517-258-0855
  • Fax: 517-210-2202
Mailing address:
  • Phone: 517-258-0855
  • Fax: 517-210-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301509808
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: