Healthcare Provider Details

I. General information

NPI: 1629042650
Provider Name (Legal Business Name): BONITA L JONES M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 AGARD AVE
BENTON HARBOR MI
49022-4051
US

IV. Provider business mailing address

960 AGARD AVE
BENTON HARBOR MI
49022-4051
US

V. Phone/Fax

Practice location:
  • Phone: 269-927-5162
  • Fax: 269-928-5319
Mailing address:
  • Phone: 269-927-5162
  • Fax: 269-928-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301084649
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: