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General NPI Number Information
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NPI Number | 1285956888
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Entity Type | Individual
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Provider Name | MARY JEAN KUJAWA MD
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Gender | Female
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 04/01/2012
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Provider Practice Location Address
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Address Line | 31 THREE MILE DR SUITE 102
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City | KALISPELL
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State | MT
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Zip | 59901-3099
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Country | US
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Telephone | 406-758-2700
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Fax | 406-758-2777
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Provider Business Mailing Address
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Address Line | 31 THREE MILE DR SUITE 102
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City | KALISPELL
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State | MT
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Zip | 59901-3099
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Country | US
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Telephone | 406-758-2700
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Fax | 406-758-2777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35-062254
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 046436
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License Number State | GA
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