Basic Information
| Provider Information | |||||||||
| NPI: | 1629042650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | BONITA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 AGARD AVE | ||||||||
| Address2: | |||||||||
| City: | BENTON HARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490224051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699275162 | ||||||||
| FaxNumber: | 2699285319 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 AGARD AVE | ||||||||
| Address2: | |||||||||
| City: | BENTON HARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490224051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699275162 | ||||||||
| FaxNumber: | 2699285319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301084649 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1907923 | 01 | MI | CIGNA | OTHER | BJ084649 | 01 | MI | DEA | OTHER | 1601110521 | 01 | MI | BLUE CROSS | OTHER | 4686697 | 05 | MI | MEDICAID | 01-30395 | 01 | MI | PHP | OTHER | P00245388 | 01 | MI | RAILROAD MEDICARE | OTHER |