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Individual

GREGORY A KONRATH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
285 W 12TH ST, STE 106, PERU, IN 46970-1653
(765) 472-8041
(765) 475-8956
Mailing address
285 W 12TH ST, STE 106, PERU, IN 46970-1653
(765) 472-8041
(765) 475-8956

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01049739A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200212630
IN
05
200343390A
OK
Enumeration date
03/14/2006
Last updated
01/18/2013
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