Healthcare Provider Details

I. General information

NPI: 1104416437
Provider Name (Legal Business Name): JONATHAN HAWBLITZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E CENTRE AVE
PORTAGE MI
49002-5500
US

IV. Provider business mailing address

15020 RANSON RD
HUNTERSVILLE NC
28078-7016
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7050
  • Fax: 269-286-7051
Mailing address:
  • Phone: 415-686-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: