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NPI Code Detail

MEDICARE: MARITHA ANN JONKMAN MD

MEDICARE: MARITHA ANN JONKMAN 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
1208000000XPediatrics Physician01053805AIN

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 : 1548239460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARITHA ANN JONKMAN MD
Provider Business Mailing Address
First Line : PO BOX 4699
Second Line :
City : LAFAYETTE
State : IN
Zip : 47903-4699
Country : US
Telephone Number : 765-449-2732
Fax Number : 765-449-1196
Provider Business Practice Location Address
First Line : 3774 BAYLEY DR
Second Line : SUITE B
City : LAFAYETTE
State : IN
Zip : 47905-8651
Country : US
Telephone Number : 765-807-8180
Fax Number : 765-807-8181
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 03/23/2021

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Directions to “ MARITHA ANN JONKMAN MD” Practice Location

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