Individual
DR. JONATHAN MARION DETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5757 MONCLOVA RD, SUITE 14, MAUMEE, OH 43537-1863
(419) 893-3316
(419) 893-2320
Mailing address
5757 MONCLOVA RD, SUITE 14, MAUMEE, OH 43537-1863
(419) 893-3316
(419) 893-2320
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
35043922
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0513331
—
OH
01
—
CB3101
RAILROAD MEDICARE
OH
Enumeration date
10/18/2005
Last updated
06/11/2008
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