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Individual

DR. JONATHAN M GWIZDALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(800) 653-6568
Mailing address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(800) 653-6568

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
4301119355
MI
390200000X
Student in an Organized Health Care Education/Training Program
0116029635
VA

Other

Enumeration date
06/20/2016
Last updated
07/08/2022
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