Individual
CLARICE HANKS KONSHOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1555 NORTHWAY DR STE 200, SAINT CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3164
Mailing address
1555 NORTHWAY DR STE 200, SAINT CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3164
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39535
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123278
MEDICA #
MN
01
—
064H1KO
MNBS #
MN
01
—
064H2KO
MNBS #
MN
01
—
064H3KO
MNBS #
MN
05
—
18686
—
MN
01
—
2387955
AMERICA'S PPO/ARAZ #
MN
05
—
907913100
—
MN
01
—
DA9041045762
PREFERRED ONE #
MN
Enumeration date
05/30/2006
Last updated
01/24/2023
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