Provider Demographics
NPI:1952304677
Name:JANTZ, JONATHAN W (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:JANTZ
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0725
Mailing Address - Country:US
Mailing Address - Phone:316-283-3627
Mailing Address - Fax:316-283-3635
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:STE 150
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9015
Practice Address - Country:US
Practice Address - Phone:316-283-7100
Practice Address - Fax:316-283-7118
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-22944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1615419OtherHEALTH PARTNERS OF KANSAS
KS1952304677OtherBLUE CROSS BLUE SHIELD
KS100115710DMedicaid
1952304677OtherTRIWEST/TRICARE
KS1190OtherPREFERRED HEALTH
KS641010OtherFIRST GUARD/HEALTHWAVE