Provider Demographics
NPI:1659078061
Name:KONKEL, SETH
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:KONKEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CHERRY ST NE APT 42
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4566
Mailing Address - Country:US
Mailing Address - Phone:757-709-8888
Mailing Address - Fax:
Practice Address - Street 1:1950 CHERRY ST NE APT 42
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4566
Practice Address - Country:US
Practice Address - Phone:757-709-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT63549872OtherDMV