Provider Demographics
NPI:1477521938
Name:MONSMA, KENNETH J (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:MONSMA
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 1:405 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1189
Mailing Address - Country:US
Mailing Address - Phone:641-628-3832
Mailing Address - Fax:641-628-8894
Practice Address - Street 1:411 MERRILL STREET
Practice Address - Street 2:
Practice Address - City:BUSSEY
Practice Address - State:IA
Practice Address - Zip Code:50044
Practice Address - Country:US
Practice Address - Phone:641-944-5813
Practice Address - Fax:641-944-5258
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16953208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2032508Medicaid
IA2032508OtherRAILROAD MEDICARE
IA56090Medicare ID - Type UnspecifiedMEDICARE NUMBER
IA56090Medicare PIN
IA2032508Medicaid