Provider Demographics
NPI:1285956888
Name:KUJAWA, MARY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:KUJAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:31 THREE MILE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3099
Mailing Address - Country:US
Mailing Address - Phone:406-758-2700
Mailing Address - Fax:406-758-2777
Practice Address - Street 1:31 THREE MILE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3099
Practice Address - Country:US
Practice Address - Phone:406-758-2700
Practice Address - Fax:406-758-2777
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-0622542084P0800X
GA0464362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry