Provider Demographics
NPI:1609988310
Name:KONZEN, JON P (DO)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:P
Last Name:KONZEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:950 W CLAIREMONT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6176
Mailing Address - Country:US
Mailing Address - Phone:715-831-0811
Mailing Address - Fax:715-831-0802
Practice Address - Street 1:3506 OAKWOOD MALL DR STE A
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2639
Practice Address - Country:US
Practice Address - Phone:715-831-0811
Practice Address - Fax:715-831-0802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI371382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30067800Medicaid
G06517Medicare UPIN
WI805880001Medicare PIN