MEDICARE: DR. JONATHAN STEWART ROUWHORST M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301110884	MI
2	207Q00000X	Family Medicine Physician	64639	WI
3	207Q00000X	Family Medicine Physician	125062119	IL

General Provider Information

NPI Number	:	1508120122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN STEWART ROUWHORST M.D.

Provider Business Mailing Address
First Line	:	15161 WILLOWWOOD CT
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-9151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15161 WILLOWWOOD CT
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417
Country	:	US
Telephone Number	:	616-402-8353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	02/12/2026

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