Individual
P JOHN KONICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-5252
Mailing address
4440 W 95TH ST, DEPARTMENT OF EMERGENCY MEDICINE, OAK LAWN, IL 60453-2600
(708) 684-5354
(708) 684-1028
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02005798A
IN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036091309
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36091309
—
IL
Enumeration date
08/15/2006
Last updated
10/23/2020
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