Individual
J EDSON PONTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 JOHN R ST, DETROIT, MI 48201-2013
(800) 527-6266
(313) 966-8207
Mailing address
400 MACK BLVD, STE 2 WEST CREDENTIALING DEPT, DETROIT, MI 48201-2153
(313) 448-9006
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301031303
MI
Other
Enumeration date
05/28/2006
Last updated
04/30/2020
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