Individual
DR. JONATHON P STATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
757 VINEWOOD, BIRMINGHAM, MI 48009
(248) 644-6029
(519) 258-7896
Mailing address
757 VINEWOOD, BIRMINGHAM, MI 48009
(248) 644-6029
(519) 258-7896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301074553
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127456
MERCY CARE CHOICES
MI
01
—
1591463
CIGNA
MI
01
—
1730121
UHC
MI
05
—
4120366
—
MI
01
—
4301074553
PHYSICIAN LICENSE
MI
01
—
5228630
AETNA
MI
01
—
700H21076
BCBSM
MI
01
—
C7104
MCARE
MI
01
—
CC3713
RR MEDICARE
MI
Enumeration date
05/17/2006
Last updated
05/06/2011
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