Provider Demographics
NPI:1386937787
Name:WOLOCKO, JONATHON R (MD)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:R
Last Name:WOLOCKO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1225 S LATSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7660
Mailing Address - Country:US
Mailing Address - Phone:810-227-2767
Mailing Address - Fax:810-227-2760
Practice Address - Street 1:1225 S LATSON RD STE 260
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7660
Practice Address - Country:US
Practice Address - Phone:810-227-2767
Practice Address - Fax:810-227-2760
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2024-02-28
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Provider Licenses
StateLicense IDTaxonomies
MI4301098851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine