Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016003378 | IL |
Y | 222Z00000X | Podiatrist | 016003378 | IL |
NPI | 1003896978 |
---|---|
Provider Name | Dr. Mark A Konieczny |
First Address | Naperville, IL 60540-8138 |
Second Address | Naperville, IL 60540-8138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 01/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T37895 | (02) | IL |