Provider Demographics
NPI:1013202340
Name:KONZEN, JON LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:LEO
Last Name:KONZEN
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 1:26 WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9464
Mailing Address - Country:US
Mailing Address - Phone:419-867-0195
Mailing Address - Fax:
Practice Address - Street 1:26 WALNUT CREEK DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9464
Practice Address - Country:US
Practice Address - Phone:419-867-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.026282208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice