Provider Demographics
NPI:1164589164
Name:JONES, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1919
Mailing Address - Country:US
Mailing Address - Phone:618-277-1130
Mailing Address - Fax:618-277-4917
Practice Address - Street 1:3990 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1919
Practice Address - Country:US
Practice Address - Phone:618-277-1130
Practice Address - Fax:618-277-4917
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003012177207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1376586685OtherNPI GROUP
MO2011019383OtherMO LICENSE
IL036117802Medicaid
IL554490Medicare PIN
ILK38645Medicare PIN
IL036117802Medicaid
ILCF8691Medicare PIN
MO2011019383OtherMO LICENSE
IL554480Medicare PIN
ILCH6508Medicare PIN