Provider Demographics
NPI:1578501003
Name:KONECKY, MARGARET ALMA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ALMA
Last Name:KONECKY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 CEDARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1220
Mailing Address - Country:US
Mailing Address - Phone:216-691-1640
Mailing Address - Fax:216-691-1640
Practice Address - Street 1:29505 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1932
Practice Address - Country:US
Practice Address - Phone:440-871-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002039213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0478111Medicaid
OH000000497422OtherANTHEM BLUE SHIELD
OH000000497422OtherUNICARE
OHT95753Medicare UPIN
OH000000497422OtherANTHEM BLUE SHIELD