Individual
JONATHAN MYLES GARDNER WILLATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MB, CHB
Contact information
Practice address
1500 EAST MEDICAL CENTER DR, B1 FLOOR UNIVERSITY HOSPITAL RECP C, ANN ARBOR, MI 48109-5030
(734) 936-4566
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301085245
MI
Other
Enumeration date
11/09/2006
Last updated
04/04/2012
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