Healthcare Provider Details

I. General information

NPI: 1477521938
Provider Name (Legal Business Name): KENNETH J. MONSMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MERRILL STREET
BUSSEY IA
50044
US

IV. Provider business mailing address

405 MONROE ST
PELLA IA
50219-1189
US

V. Phone/Fax

Practice location:
  • Phone: 641-944-5813
  • Fax: 641-944-5258
Mailing address:
  • Phone: 641-628-3832
  • Fax: 641-628-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16953
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: