Provider Demographics
NPI:1730289257
Name:KONOW, DANIEL R (PA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:KONOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13211 ACADIA CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9072
Mailing Address - Country:US
Mailing Address - Phone:260-484-6767
Mailing Address - Fax:
Practice Address - Street 1:11143 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1727
Practice Address - Country:US
Practice Address - Phone:260-484-8830
Practice Address - Fax:260-446-3600
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant