Basic Information
| Provider Information | |||||||||
| NPI: | 1336137546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KONTOS | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 ILLINI DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | SILVIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612822904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3092812120 | ||||||||
| FaxNumber: | 3092812129 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 ILLINI DR | ||||||||
| Address2: | STE 304 | ||||||||
| City: | SILVIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612822907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3092812120 | ||||||||
| FaxNumber: | 3092812129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 04/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036-117105 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.