Provider Demographics
NPI:1356528855
Name:W. S. KONETZKI , M.D., P.C.
Entity type:Organization
Organization Name:W. S. KONETZKI , M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:KONETZKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-487-0550
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-0605
Mailing Address - Country:US
Mailing Address - Phone:205-487-0550
Mailing Address - Fax:205-487-0553
Practice Address - Street 1:200 CARRAWAY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5048
Practice Address - Country:US
Practice Address - Phone:205-487-0550
Practice Address - Fax:205-487-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28471208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID #