Provider Demographics
NPI:1225088057
Name:KONASIEWICZ, STEFAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:J
Last Name:KONASIEWICZ
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 1:1227 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2313
Mailing Address - Country:US
Mailing Address - Phone:361-883-4323
Mailing Address - Fax:361-883-4324
Practice Address - Street 1:1227 3RD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2313
Practice Address - Country:US
Practice Address - Phone:361-883-4323
Practice Address - Fax:361-883-4324
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2517207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN475723800Medicaid
MN475723800Medicaid