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General NPI Number Information
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NPI Number | 1386937787
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Entity Type | Individual
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Provider Name | JONATHON R WOLOCKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 1225 S LATSON RD STE 260
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City | HOWELL
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State | MI
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Zip | 48843-7660
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Country | US
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Telephone | 810-227-2767
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Fax | 810-227-2760
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Provider Business Mailing Address
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Address Line | 1225 S LATSON RD STE 260
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City | HOWELL
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State | MI
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Zip | 48843-7660
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Country | US
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Telephone | 810-227-2767
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Fax | 810-227-2760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301098851
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License Number State | MI
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