Provider Demographics
NPI:1760582316
Name:JONAS, ROY E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:E
Last Name:JONAS
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 1:300 RIVERSIDE DR STE 2400
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5068
Mailing Address - Country:US
Mailing Address - Phone:815-935-4907
Mailing Address - Fax:815-935-1723
Practice Address - Street 1:300 RIVERSIDE DR STE 2400
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5068
Practice Address - Country:US
Practice Address - Phone:815-935-4907
Practice Address - Fax:815-935-1723
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102006208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-3167726OtherGROUP TAX ID#
IL4632039OtherBC GROUP#
IL36102006Medicaid