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General NPI Number Information
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NPI Number | 1487604542
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Entity Type | Individual
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Provider Name | JON MICHAEL MAXWELL MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 227 RIVERSIDE AVE
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City | ADRIAN
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State | MI
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Zip | 49221-1582
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Country | US
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Telephone | 517-263-0575
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Fax | 517-265-5188
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Provider Business Mailing Address
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Address Line | 227 RIVERSIDE AVE
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City | ADRIAN
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State | MI
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Zip | 49221-1582
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Country | US
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Telephone | 517-263-0575
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Fax | 517-265-5188
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | JM051623
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 35070366
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License Number State | OH
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