Basic Information
| Provider Information | |||||||||
| NPI: | 1457340267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONAIS | ||||||||
| FirstName: | CONSTANTINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2255 MONARCH DR | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605634164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303001125 | ||||||||
| FaxNumber: | 6303001394 | ||||||||
| Practice Location | |||||||||
| Address1: | 2255 MONARCH DR | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605634164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303001125 | ||||||||
| FaxNumber: | 6303001394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036062093 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02222543 | 01 | IL | BCBS | OTHER | 036062093 2 | 05 | IL | MEDICAID |