Provider Demographics
NPI:1164512224
Name:KONELL, BENJAMIN LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LOUIS
Last Name:KONELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8703
Mailing Address - Country:US
Mailing Address - Phone:850-494-4600
Mailing Address - Fax:
Practice Address - Street 1:4262 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8703
Practice Address - Country:US
Practice Address - Phone:850-494-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4871OtherSTATE LIC. # DR. KONELL
CA20A4871OtherSTATE LIC. # DR. KONELL
CA20A4871OtherSTATE LIC. # DR. KONELL