Brian K Konowalchuk, | |
3509 Dewey St, Manitowoc, WI 54220-5497 | |
(920) 686-5732 | |
Not Available |
Full Name | Brian K Konowalchuk |
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Gender | Male |
Speciality | Preventive Medicine - Occupational Medicine |
Location | 3509 Dewey St, Manitowoc, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1104939453 | NPI | - | NPPES |
178445500 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2083X0100X | Preventive Medicine - Occupational Medicine | 49755 (Wisconsin) | Primary |
Entity Name | Aurora Medical Group, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1427271378 PECOS PAC ID: 6709794258 Enrollment ID: O20031105000725 |
Entity Name | Baycare Aurora Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1255387726 PECOS PAC ID: 0244130557 Enrollment ID: O20051012000579 |
Mailing Address | Practice Location Address |
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Brian K Konowalchuk, Po Box 735044, Chicago, IL 60673-5044 Ph: () - | Brian K Konowalchuk, 3509 Dewey St, Manitowoc, WI 54220-5497 Ph: (920) 686-5732 |
Dr. Robert W White Jr., M.D. Preventive Medicine Medicare: Medicare Enrolled Practice Location: 1520 S 41st St, Manitowoc, WI 54220 Phone: 920-320-4660 | |
Dennis B Phillips, DO Preventive Medicine Medicare: Not Enrolled in Medicare Practice Location: 601 Reed Ave, Manitowoc, WI 54220 Phone: 920-793-7300 |