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NPI Code Detail

MEDICARE: JANTINA R VONK MD

MEDICARE: JANTINA R VONK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician34728WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396798914
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANTINA R VONK MD
Provider Business Mailing Address
First Line : 1425 RED CLOUD LANE
Second Line :
City : MADISON
State : WI
Zip : 53704
Country : US
Telephone Number : 608-245-1665
Fax Number :
Provider Business Practice Location Address
First Line : 625 W WASHINGTON AVE
Second Line :
City : MADISON
State : WI
Zip : 53703-2637
Country : US
Telephone Number : 608-280-2510
Fax Number : 608-280-2426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/08/2007

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