Healthcare Provider Details

I. General information

NPI: 1073433454
Provider Name (Legal Business Name): JOHNATHAN LEE DUPERON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E ASHMAN ST
MIDLAND MI
48642-4777
US

IV. Provider business mailing address

1322 E ASHMAN ST
MIDLAND MI
48642-4777
US

V. Phone/Fax

Practice location:
  • Phone: 989-430-2324
  • Fax:
Mailing address:
  • Phone: 989-430-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: