Individual
MR. STANISLAV KONONOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5215 N IRONWOOD RD STE 104, GLENDALE, WI 53217-4908
(414) 334-1023
Mailing address
2222 E BELLEVIEW PL APT 104, MILWAUKEE, WI 53211-4005
(414) 334-1023
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3048-146
WI
Other
Enumeration date
03/29/2022
Last updated
03/29/2022
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