Basic Information
| Provider Information | |||||||||
| NPI: | 1073824207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONICEK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9874 W PRAIRIE GRASS WAY | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531327201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474047853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3801 SPRING STREET | ||||||||
| Address2: | |||||||||
| City: | RACINE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534031010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626874011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2010 | ||||||||
| LastUpdateDate: | 07/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 64321-21 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.