Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 01049739A | IN |
NPI | 1013986926 |
---|---|
Provider Name | Gregory A Konrath |
First Address | Peru, IN 46970-1653 |
Second Address | Peru, IN 46970-1653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 18/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200212630 | (05) | IN |
200343390A | (05) | OK |
G39353 | (02) | IN |