Provider Demographics
NPI:1629042650
Name:JONES, BONITA L (MD)
Entity type:Individual
Prefix:DR
First Name:BONITA
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 AGARD AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4051
Mailing Address - Country:US
Mailing Address - Phone:269-927-5162
Mailing Address - Fax:269-928-5319
Practice Address - Street 1:960 AGARD AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4051
Practice Address - Country:US
Practice Address - Phone:269-927-5162
Practice Address - Fax:269-928-5319
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084649207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1907923OtherCIGNA
MI1601110521OtherBLUE CROSS
MI4686697Medicaid
MI01-30395OtherPHP
MIP00245388OtherRAILROAD MEDICARE
MIP00245388OtherRAILROAD MEDICARE
MI1907923OtherCIGNA
MIH65855Medicare UPIN
MI01-30395OtherPHP