MEDICARE: KENNETH L JONAS 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
1	207Q00000X	Family Medicine Physician	9787	MT

General Provider Information

NPI Number	:	1063468858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH L JONAS MD

Provider Business Mailing Address
First Line	:	202 CONWAY DR
Second Line	:	SUITE 100
City	:	KALISPELL
State	:	MT
Zip	:	59901-3112
Country	:	US
Telephone Number	:	406-751-5662
Fax Number	:	406-755-0971

Provider Business Practice Location Address
First Line	:	202 CONWAY DR
Second Line	:	SUITE 100
City	:	KALISPELL
State	:	MT
Zip	:	59901-3112
Country	:	US
Telephone Number	:	406-751-5662
Fax Number	:	406-755-0971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	02/01/2008

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