Provider Demographics
NPI:1972855989
Name:KONTOS, PAMELA P (NP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:P
Last Name:KONTOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 KEDZIE AVE
Mailing Address - Street 2:DIABETES WELLNESS CENTER
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2029
Mailing Address - Country:US
Mailing Address - Phone:708-213-3286
Mailing Address - Fax:708-213-0196
Practice Address - Street 1:18350 KEDZIE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2758
Practice Address - Country:US
Practice Address - Phone:708-365-1055
Practice Address - Fax:708-799-1258
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009859363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-2169147Medicaid
IL36-2169147Medicare PIN
IL36-2169147Medicare UPIN
36-2169147Medicare UPIN
36-2169147Medicare PIN
IL362169147Medicare Oscar/Certification