Provider Demographics
NPI:1194774984
Name:ROWE, JONATHAN A (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:ROWE
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 1:1052 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1734
Mailing Address - Country:US
Mailing Address - Phone:269-343-1684
Mailing Address - Fax:269-343-5375
Practice Address - Street 1:1052 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1734
Practice Address - Country:US
Practice Address - Phone:269-343-1684
Practice Address - Fax:269-343-5375
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073718207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4113129Medicaid
MI5141688OtherAETNA
MI180036772OtherRAILROAD MEDICARE
MI180C911240OtherBCBSM
MI383309299006OtherTRICARE
MI0830166OtherIBA/PHP
MI135840000OtherDEPARTMENT OF LABOR
MI120412OtherGREAT LAKES HEALTH PLAN
MI383309299069OtherCOMMUNITY CHOICE
MI5141688OtherAETNA
MI180C911240OtherBCBSM