Provider Demographics
NPI:1043236128
Name:KONTNY, BILLIE G (MD)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:G
Last Name:KONTNY
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 1:212 MILWAUKEE AVE W
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2022
Mailing Address - Country:US
Mailing Address - Phone:920-563-7900
Mailing Address - Fax:920-563-0258
Practice Address - Street 1:212 MILWAUKEE AVE W
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2022
Practice Address - Country:US
Practice Address - Phone:920-563-7900
Practice Address - Fax:920-563-0258
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34639-020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31954200Medicaid
WIBK3693567OtherDEA
WI000930345Medicare PIN
WI31954200Medicaid