Healthcare Provider Details

I. General information

NPI: 1689775447
Provider Name (Legal Business Name): STEPHEN M. KONIECZNY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 N BROADWAY STE 1400
DENVER CO
80203-5605
US

IV. Provider business mailing address

4550 MONTGOMERY AVE STE 3
BETHESDA MD
20814-3886
US

V. Phone/Fax

Practice location:
  • Phone: 303-409-4444
  • Fax: 347-440-0031
Mailing address:
  • Phone: 313-488-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2307
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0002307
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: