Provider Demographics
NPI:1669051405
Name:CONSTANTAKIS, JOHN W (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:CONSTANTAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 UNIVERSITY BAY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2299
Mailing Address - Country:US
Mailing Address - Phone:608-264-3093
Mailing Address - Fax:
Practice Address - Street 1:800 UNIVERSITY BAY DR STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2299
Practice Address - Country:US
Practice Address - Phone:608-264-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77601-212084N0400X, 207P00000X
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program