Provider Demographics
NPI:1144261876
Name:KONOWAL, ALEXANDRA (DO)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KONOWAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 CORKSCREW PALMS CIR
Mailing Address - Street 2:#3
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3307
Mailing Address - Country:US
Mailing Address - Phone:239-948-7555
Mailing Address - Fax:239-948-8077
Practice Address - Street 1:9500 CORKSCREW PALMS CIR
Practice Address - Street 2:#3
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3307
Practice Address - Country:US
Practice Address - Phone:239-948-7555
Practice Address - Fax:239-948-8077
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7169207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F72000Medicare UPIN
P00074663Medicare PIN
FL57312UMedicare PIN
FL5030770001Medicare NSC