Basic Information
| Provider Information | |||||||||
| NPI: | 1477521938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONSMA | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | PELLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502191189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416283832 | ||||||||
| FaxNumber: | 6416288894 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 MERRILL STREET | ||||||||
| Address2: | |||||||||
| City: | BUSSEY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6419445813 | ||||||||
| FaxNumber: | 6419445258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 16953 | IA | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 2032508 | 05 | IA | MEDICAID | 2032508 | 01 | IA | RAILROAD MEDICARE | OTHER |