MEDICARE: JONATHAN DUANE PRICE

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	247200000X	Other Technician	P 620 435 155 552	MI

General Provider Information

NPI Number	:	1720433980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DUANE PRICE

Provider Business Mailing Address
First Line	:	9507 MONROE RD
Second Line	:
City	:	SAINT HELEN
State	:	MI
Zip	:	48656-8215
Country	:	US
Telephone Number	:	616-902-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	9507 MONROE RD
Second Line	:
City	:	SAINT HELEN
State	:	MI
Zip	:	48656-8215
Country	:	US
Telephone Number	:	616-902-9260
Fax Number	:

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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Directions to “ JONATHAN DUANE PRICE ” Practice Location

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