Healthcare Provider Details

I. General information

NPI: 1912295783
Provider Name (Legal Business Name): JONATHAN M DEMING D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S PARK ST STE 1
KALAMAZOO MI
49001-5600
US

IV. Provider business mailing address

1212 S PARK ST STE 1
KALAMAZOO MI
49001-5600
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-0874
  • Fax: 269-344-7256
Mailing address:
  • Phone: 269-344-0874
  • Fax: 269-344-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901400380
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: