Individual
JONATHAN WAXMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4201 SAINT ANTOINE ST, UHC 5-E, DETROIT, MI 48201-2153
(313) 577-0804
Mailing address
4201 SAINT ANTOINE ST, UHC 5-E, DETROIT, MI 48201-2153
(313) 577-0804
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
4301105881
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/14/2014
Last updated
07/19/2019
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