Healthcare Provider Details

I. General information

NPI: 1891760344
Provider Name (Legal Business Name): JOHN T KONTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 SUNSET LAKE BLVD SUITE 401
VENICE FL
34292-7551
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-497-8220
  • Fax: 941-497-8239
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME65954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: