MEDICARE: DENNIS J KONTRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	15656 020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306835319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS J KONTRA MD

Provider Business Mailing Address
First Line	:	5802 WASHINGTON AVE
Second Line	:	STE 102
City	:	RACINE
State	:	WI
Zip	:	53406-4088
Country	:	US
Telephone Number	:	262-886-9100
Fax Number	:	262-886-9130

Provider Business Practice Location Address
First Line	:	5802 WASHINGTON AVE
Second Line	:	STE 102
City	:	RACINE
State	:	WI
Zip	:	53406-4088
Country	:	US
Telephone Number	:	262-886-9100
Fax Number	:	262-886-9130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/28/2008

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