Organization
DJ KONTRA MD & ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS J KONTRA MD (PRESIDENT)
(262) 886-9100
Entity
Organization
Contact information
Practice address
5802 WASHINGTON AVE, STE 102, RACINE, WI 53406-4050
(262) 886-9100
(262) 886-9130
Mailing address
5802 WASHINGTON AVE, STE 102, RACINE, WI 53406-4050
(262) 886-9100
(262) 886-9130
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32784900
—
WI
01
—
CT1058
RAILROAD MEDICARE
WI
Enumeration date
10/21/2005
Last updated
04/25/2008
Update your record
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