Mongold, Jonathan M

Mongold, Jonathan M is an individual health care provider with primary practice located at 5177 Mccarty Ln , Lafayette IN 47905-8764. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Sports Medicine, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Mongold, Jonathan M can be contacted via phone (765) 448-8000.

Contact Information

Primary practice address
5177 Mccarty Ln Lafayette IN 47905-8764
Phone: (765) 448-8000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 02005180A Indiana
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 02005180A Indiana
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 02005180A Indiana

Profile Details

NPI number 1205179553
LBN Legal business name Mongold, Jonathan M
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2013
Last updated Jan 27th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205179553 NPPES
Indiana MEDICAID 300005550
Indiana Other 000001116759
Indiana Other 000001106441
Indiana Other 000001117320

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